Five Impactful Tools for Your C-Section Recovery

Wednesday, September 22, 2021

Cesarean Recovery

Written by: Sarah Everly

No matter how we bring our children into this world, our bodies will have some healing to do. Bringing a baby earthside is physically taxing, and involves so many different systems of the human body. In the case of cesarean delivery, there are a few more steps added to the recovery process. We tend to neglect these steps when leaving the hospital, but it’s important to know what tools are available in your recovery toolbox. Here are the five most impactful tools that ensure a faster and more complete recovery. 

  1. 1. Walking- After surgery your epidural or spinal will be removed and over the next few hours the numbness will begin fading away. While you may leave the OR expecting to take it as easy as possible, you will quickly find that the first task on your “to-do list” is getting up and taking a walk through the hospital corridor. While this can be painful and feel like it adds insult to injury, ambulation is imperative to proper recovery. Why? Because it is the action of walking that jumpstarts our body’s routine functionalities. Walking as soon as possible after surgery, and continuing to take several short walks around your home each day encourages proper blood circulation, decreases the risk of blood clots, disperses any built up gas and the pain that it may be causing, has been shown to lower the need for narcotic pain relief, shorten hospital stay length, and ensures that the muscle movements of your digestive tract begin working as soon as possible which will lead to less constipation and discomfort throughout the coming weeks. 
  2. 2. Proper Nutrition- Several studies have tested the efficacy of enhanced recovery after surgery pathways (ERAS). These pathways include measures such as decreasing the amount of time patients go without food and drink, encouraging early mobility as we covered above, providing regional anesthesia, etc… One pathway found to be very helpful is not only a proper nutritious diet both before and after surgery, but also ensuring limited interruptions to that diet during the pre and postoperative periods. Keeping fasting to a minimum has shown to have many benefits. These benefits include reducing pain levels, stabilizing blood sugar, and reducing tissue hypoxia. Because of these benefits the American College of Gynecology (ACOG) has encouraged providers to use this pathway. It is now recommended that liquids in moderation should be encouraged up until 2 hours prior to surgery, and instead of no food by mouth policies starting 12 hours prior to surgery it has been decreased to 6 hours. Food and drink is encouraged between two and four hours postoperative. 
  3. 3. Abdominal Binders- Abdominal binders are one of the most underutilized recovery tools in the post cesarean (post birth) toolbox. While not widely studied, there are small randomized case studies on their benefits. In a study of 89 patients, all with similar hemoglobin and hematocrit levels, it was found that the group of participants that were given abdominal binders not only had better hemoglobin and hematocrit levels at 36 hours post surgery, but they reported lower pain levels as well. Binders are also instrumental in supporting the return of postpartum abdominal muscles to their original placements. While all mothers will experience some degree of Diastasis Recti, binders can prevent this muscle separation from advancing, and help close the gap overall. 
  4. 4. Pain Management- Unfortunately cesarean recovery can come with a great deal of pain. Bending, standing, walking, and even turning over in bed can become difficult tasks even with pain medications, let alone without. Because of this, pain management is one of the most important parts of a proper recovery plan. Not only does adequate pain management keep the patient in a certain level of comfort, It will reduce the overall length of opioid usage, shorten the length of hospital stays, aid in returning to normal functionality, lead to a higher level of maternal satisfaction, which in turn effects breastfeeding, bonding, and postpartum mood. While opioid usage is still the most effective and most common form of pain management, there are local anesthesia options being used in select hospitals that can deliver lidocaine or marcaine directly into the incision. One form of this is known as the ON-Q pump. This small pump delivers numbing medication to the incision site through a small catheter placed within it. These pumps will be sent home with you, and will last an average of three to five days post-op. Afterwards it can be gently pulled out of the incision. While this sounds scary, I assure you from my personal experience that it does not hurt, and in fact is hardly even felt. This mode of pain management is not available at all hospitals and it may be worth inquiring about prior to settling on a birth location. These pain management options may not entirely cut out the use of opioid pain relief, but it is likely to decrease the amount needed and the length of use.
  5. 5. Birth Processing- In many cases, a mother may have arrived on the OR table after a scary or confusing turn of events. The fear of getting to the OR and the fear of Being in the OR can bring about a trauma response, and this may affect her overall feelings about her birth even after that fear has passed. The mental health aspect of birth is overlooked across the board, not just with cesareans, but we commonly see trauma based mental health issues arise after traumatic births. Having access to proper therapies and a support system in place is vital to the postpartum experience. Without these we may see this trauma develop into a myriad of postpartum mood disorders which can leave long lasting impacts in the life of mom, baby, and family. Without mental health, there can be no physical health. 

Post Written By: Sarah Everly, Tranquility by HeHe Team Member


Check out more about Sarah here!

Resources:

Things that F*ck Up your Birth Plan, A Series

Wednesday, September 8, 2021

Things that F*ck Up your Birth Plan


LATE PREGNANCY ULTRASOUNDS

Ultrasounds are a ‘normal’ part of pregnancy if you ask any American woman—BUT if we look at the science behind them, you might be surprised at what you find…

While you may enjoy seeing your baby, it’s worth discussing the risks before saying ‘yes’ to any and all ultrasounds and scans. Pregnant people routinely go through a number of ultrasounds during pregnancy. 

Most commonly:
  • - 11-14 weeks to confirm pregnancy
  • - 18-22 weeks to confirm anatomy is looking normal
  • - 35-38 weeks which is known as the growth scan (we check the ‘size of baby’ and baby’s position)
I put ’size of baby’ in quotations because the accuracy of ultrasounds is so laughable that it’s ridiculous to lead anyone to ever believe we could accurately predict the size of a baby that way. Ultrasounds also get less and less accurate as the baby grows. However, there are risks with late-pregnancy ultrasounds and some are severe like misdiagnosis, unnecessary inductions, and unnecessary c-sections. There is a fine line between intervening and monitoring—sometimes, checking in actually hinders the process

The Science

This 2015 Cochrane Review of Late Pregnancy Ultrasounds (after 24-weeks) found, ‘there were no differences between groups in the rates of women having additional scans, antenatal admissions, preterm delivery, induction of labour, or instrumental deliveries although the rate of caesarean section increased slightly with screening. For babies, birthweight, condition at birth, interventions such as resuscitation, and admission to special care were similar between groups. Infant survival, with or without congenital abnormalities, was no different with and without routine screening, and childhood development at eight to nine years was similar in the three trials that measured it. None of the trials reported on psychological effects for mothers of routine ultrasound in late pregnancy.’ You can also find the 2008 original version of this paper here.

During the 1970’s a few major key players in maternity care changed —for better or worse (feels like worse). First, Electronic Fetal Monitoring was introduced and promised to reduce infant mortality which it has not done, but it has increased c-sections and maternal complications astronomically. Coincidentally, this is also the time that we saw c-section rates go from 5% (1970) to nearly 25% by 1988! 

The Benefit

There are other functions of this third trimester ultrasound like checking for baby’s position, placenta position, evaluates (not with great accuracy) amniotic fluid levels, and can detect any late term abnormalities (cardiac complications, abnormalitites in kidneys or urinary systems or central nervous systems). Isabel Monier, a French Researcher, has long said, ‘Neonatal outcomes were not better for SGA infants if FGR was suspected.’

The F*ck Up 

The Global View You know I love looking at other countries and this 2013 Journal of Obstetrics and Gynecology Canada article shares, “In women without risk factors for intrauterine growth restriction, comprehensive third trimester ultrasound examination including biophysical profile, fetal biometry, amniotic fluid volume, and umbilical artery Doppler studies is not recommended. (II-2D).” Based on existing evidence, routine late pregnancy ultrasound in low risk or unselected populations does not confer benefit on mother or baby. There is no evidence that it should be recommended routinely in late pregnancy, yet this is the standard practice across the United States.

The Small Baby There is ‘the difficulty in distinguishing between those SGA that truly have an FGR problem and those constitutional SGA which entails a high false positive rate.’ Another study found that even with risk factors identified, it was still challenging to get accurate results. The artihttps://pubmed.ncbi.nlm.nih.gov/26488771/cle states, ‘However, despite the presence of these factors, 60% of SGA and 40% of severely SGA infants, respectively, were not suspected of FGR.’

The Provider Bias Your provider’s bias can be more influential than the actual screening results! Customizing fetal size for maternal height, weight and ethnicity, has been shown to improve the identification of babies who are small because of FGR, rather than constitutional reasons.

The Manipulation The issue with constant monitoring —besides how inaccurate the results are— is that it opens up the conversation for scary, fear-based manipulation. Expecting every body and every baby to do exactly the same exact thing is unrealistic. Obstetricians, and some midwives, will give care from a place of ‘looking for a problem’ rather than ‘responding to whatever the body shares.’ Looking for a problem says ‘go for a ‘just in case scan’ even though you’re not yet in the range that I’d be concerned,’ whereas responding says ‘you’re in the normal range but let’s watch it.’

The Gender Bias There is also one last bias that we should all expect at this point—but female gendered fetuses are more likely to be suspected of FGR. https://pubmed.ncbi.nlm.nih.gov/26488771/

So since this routine practice doesn’t improve outcomes and leads to higher rates of stress and unnecessary worry for pregnant people—why are we still recommending this across the board? 

Late pregnancy ultrasounds should be something you have to ‘risk’ into meaning that we don’t give them to everyone as the current US medical system does. Only folks who have risk factors or individual factors that lead us to believe they may have increased risk that we may be able to mitigate if we catch it via a 3rd trimester ultrasound. But, these complications are so rare and that’s why not everyone needs them. 

The Risk

Unless you need one, they are unnecessary interventions that have the major potential to disrupt your birth plan by causing unnecessary drama or courses of action. Consenting to extra ultrasounds after 24-weeks should be a very calculated decision in which you understand the risk of just how inaccurate the results can be plus the risk of opening the door to pressure and manipulation from medical staff. If you understand the risk and feel comfortable navigating that — I support you.

Are there risks to having Small For Gestational Age babies?

Yes, there are risks to everything. This article shares clearly the risks associated with small for gestational age. One thing that people always forget to look at are your own genetics.
  • - What did you weight at birth?
  • - What about the baby’s other parent?
  • - How big of a human are you now?
  • - What about the baby’s other parent?
If this baby is made by two relatively small people, why would we expect your body to grow a 11lb baby! I am a very petite person at 5’4” and 100lbs. My partner is not a large guy, either with a height of just 5’6”. We have no reason to believe the two of us would make a ginormous baby. So genetics matter. Small people make small babies and that’s okay. It almost feels like that’s how nature intended it to be. 

More so than the risks to your baby, thisis about making sure that you need the initial scans in the first place. When we intervene (with anything—even as little and seemingly harmless as an ultrasound), we must understand the risks associated with it and not just the physical ones! We must also think about the rate of false-positives (where you believe you or your baby has something bad, but you/they don’t) and false-negatives (where you falsely believe you and your baby are safe/in the clear and you are not). This is one stat that providers fail to mention with almost ALL care—with how much certainty can they give you this answer? With ultrasounds—it’s not very certain!

You can see how using a notoriously inaccurate tool, like ultrasound, to diagnose such a hard thing to distinguish to begin with (SGA vs FGR) can lead to a few twists and turns in your labor story. 

The Birth Lounge will help prepare you for all of those twists and turns so you know exactly what your options are at each step of the way. You’ll also learn the pro’s and con’s plus the appropriate timing of each intervention and how they might interact with other interventions along the way!

All of the content is accessible via an app that conveniently goes into the birth room with you so you can have lounge support from start to finish!

Alcohol in Pregnancy

Wednesday, July 14, 2021

Alcohol in Pregnancy

Today I wanted to chat alcohol and pregnancy. I sometimes see or hear expectant parents make jokes like, 'I wish I could have a glass of wine'. And I just wonder to myself, is this a place for me to say, 'You can'. Actually, the research says that it is okay. Or are these people like truly joking?

I feel like this is a discussion we should have. Now I think if we're gonna understand drinking during pregnancy and postpartum, we first have to break down how your body breaks down and absorbs alcohol. And a lot of people have this misconception that you drink alcohol and then it's just zooms to your baby. Or you drink alcohol while you're breastfeeding and your baby just gets a serving of alcohol with the next feed. It's just not like that. You ingest the alcohol and it goes into your digestive system and then it goes into your bloodstream and then your liver is actually going to filter the alcohol. Some alcohol can pass into the placenta, however your baby can process and break down a small amount of alcohol. 

There's also a big misconception that you can't have alcohol in the first trimester. And the science says that that too is just not true. So how much alcohol are we talking? One to two glasses per week, not per day- per week- is okay in the first trimester. After you get to the end of the first semester and you enter your second and third trimester, you can have up to one glass a day. Professor Oster goes into this in her book about how the social construct of drinking during pregnancy actually might be hindering our pregnancies and our children. Professor Osters books are fabulous for research-based information for pregnancy and parenthood. She covers this topic at length in her book, 'Expecting Better'. Her book, 'Crib Sheet', is an amazing resource for controversial topics in parenthood such as drinking while breastfeeding as well. 

So what are the concerns with drinking during pregnancy? One concern for those that drink during pregnancy is fetal alcohol syndrome. This includes cognitive delays, developmental delays, physical abnormalities, and language delays. A 2009 study in Australia actually did show that there are language delays in children whose mothers binge drank while they were pregnant in the second and third trimester.

Let's talk about breastfeeding and drinking. The science again is really clear because our bodies are so complex and it doesn't go straight from you straight into your breast milk. There was a 2014 study done and it showed that if you drank four drinks quickly, I think it was defined as within an hour, that even then there was not enough exposure of alcohol in the breast milk to even be mentionable. And that is incredible. It's important to remember that the alcohol that's found in your breast milk can be said to be the same as your blood alcohol content. 

We also know that alcohol is not stored in breast milk despite anything you've ever heard. So the rule of thumb there is that you can have a glass of wine. There is no need to pump and dump. If you are concerned about this milk you can wait two hours to feed your baby after one drink. If you prefer not to feed that milk to your baby, you can pump that milk to use it in a bath, use it for soap, use it for skin issues, use it for ear infections, for pink eye, diaper, rash, all sorts of stuff. Do not pump and dump that precious, precious milk.

The bottom line about alcohol in pregnancy. There's no good evidence to suggest that light drinking during pregnancy negatively impacts your baby. This means up to one drink a day in the second and third trimesters or one to two drinks a week in the first trimester. Speed matters. So we are certainly not talking about vodka shots. Heavier drinking has negative impacts, especially in the range of four to five drinks at a time. 

Also remember in pregnancy, your baby does have the ability to break down some alcohol. So if you're being responsible and you are being mindful of your alcohol intake in both pregnancy and postpartum, you should be all set to go. I know this is a sticky topic, and I know it's something that people feel really, really strongly about. I don't care what you do, but I don't want you to not have a drink in pregnancy or postpartum because you think that it's going to harm your baby because that's just not the truth. I definitely don't want you to not have a drink in pregnancy and postpartum because of the social construct, because that's just silly. The science is there. The research is clear. So go forth and have that glass of wine. If you have been withholding from yourself for the last few months you deserve it. 

Isolation in New Parenthood with Bryce Reddy

Wednesday, June 30, 2021

COVID and Isolation in New Parenthood with Bryce Reddy

(Derived from an Episode of The Birth Lounge Podcast with Bryce Reddy)

Many of the resources that parent might have had before are just not possible right now. Before, we would go to the library, we would go to a breastfeeding class, or we would have many other opportunities to get out of the house at least. You could go roam around the store when you just needed to get out and see other human beings. And that isn't as possible right now. Maybe depending on people's comfort level they can maybe go to the grocery store, but who knows? 

This isn't how it's supposed to be. We were supposed to be welcomed home by grandparents. We were supposed to have people coming by and dropping off food and holding the baby. So you could take a shower. There's grief in that this isn't what it was supposed to look like. Obviously, we can't change that right now. So, remembering that we're allowed to grieve this process. We're allowed to grieve what this looks like right now and find a way through it. 

Really being able to just sit in that grief and say, you know, 'this is sad'. This is a loss, this is a loss for what this is, you know, this loss isn't just for the pandemic. It also might be, my baby was born premature and our newborn days were spent in the NICU. Or my baby was born and my marriage isn't doing very well. There is grief when things don't look like the picture we imagined in our minds and we're allowed to feel that and grieve it. That's really the only way through it.

We've been tasked with an extraordinary circumstance. This is not normal and I never want to normalize it. We are all in a survival state right now that we're just figuring out as we go along. So there is a lot of adjusting that happens. The rhythm of our lives has totally been shifted. 

I think finding new ways to function within this role has been a process. So we need to be able to identify when something isn't working for us and opening up that conversation, which isn't always easy to have in person. Like we can't go to the park or we can't go to the store and asking for help in those moments or communicating to your partner that you don't want to always have to ask. There has to be some give and take here. Being open to these conversations is what we need to be flexible in these transitions.

We have to remember that the mental health of children is closely related to their parents' mental health. In many ways, parents are feeling left behind in this pandemic. It's very easy to look from an employer's lens and not quite get how intensely parents' lives have been. Especially parents of young children whose lives have been toppled upside down. We're taking care of children 24 hours a day, where we used to have these other providers available to us. I think that the more we can focus on and support parents- we can foster the mental health of the children and the babies involved. They're starting to look closer at the research for how this is impacting babies and small children, but I always like to go back to the fact that babies and kids are so resilient. 

I've seen it even in my own kids when this all first started, but now 10 months in like they're focused, they're doing pretty well. They wear a mask to school and don't seem bothered by it at all. They talk to their grandparents on zoom, which isn't the same of course, but they're still connected in some way. I think focusing on the resilience of our kids is the best we can do. As well as tuning into ourselves and taking care of our own mental health so that we can provide a safe an grounded place for our kids to be living within. The more that we can help ourselves feel safe and grounded the more we can provide that for our kids and our babies.

Invisible Load of Motherhood

I think we've all been socialized to fit into certain roles within our families. Certain things are taken care of by one parent and certain things are taken care of by another parent. And it was invisible because it was just done and nobody talked about it. We're in a new generation now and a time where it has to be talked about because our families look different now. There are two primary workers within most parent relationships. Right? So the primary caretaker might have a whole lot more responsibilities than just the home. They might have a business or they might have a high powered job, or they might have a side hustle, whatever.

These kinds of norms have to shift as well, but they haven't because that's just what happens. We've been socialized to just take on certain roles. That's work. Those are all those decisions that we're making each day. 

There is just so much that goes into everyday life. It isn't always visible, hence the invisible Motherload that we often talk about. And I think one benefit of this pandemic is being home together all the time might be opening eyes to that, or might be forcing these conversations to happen when they might not previously have been going on. Having those frustrations rise enough to verbalize our need for some more support. I think it's forcing some conversations to happen.

Tensions at Home 

I think there can be sometimes a lot of pressure to have a verbal conversation. Otne thing I often recommend to parents is to even just to text each other, to take the pressure off because when we do an in person, it's very easy to get very reactive. We feel attacked or threatened by what's coming at us. If we're not in kind of a very regulated place and sometimes doing it over text messages, which is something my husband and I do all the time is if I have something that's on my mind, I usually text it to him first. 

Then he knows there is something that bothers me. And then we can talk about it later. Finding these workarounds to being able to open and start facilitating these conversations. These conversations have to happen and tensions are rising. Of course they're rising because we're all under severe stress, you know? Prioritizing that with our partner on both ends of the spectrum saying like, ''Do you need a break right now?' 

Acknowledging that this tension is going to happen. We're not talking super severe tension that would require a lot more support from a clinician, but really acknowledging that we're in survival state right now. Going back to self care, super basic stuff. Making sure you're getting showers and getting clean clothes on each day. Getting out for a walk by yourself. Maybe if you have 15 minutes or even just a drive to go get drive through coffee. Acknowledging we're in a tough spot. We both need to kind of focus on our self care and calling each other out on that. Acknowledging those unmet needs that are really deep right now. 

Re-Kindling Romance While Stuck at Home

I always talk about at-home dates. Watching a show, putting your phones down, turning your phones off, you know? Cause I think that that can be a real area where we think we're spending time with someone, but we're also like scrolling Instagram or Facebook or reading the news. And we're physically next to each other, but we're not connected. I always recommend even something super simple like that- sitting on the couch with your phones off together watching a show or sometimes reading the same book as one another and being able to talk about it.

Finding those little things that we can do to maintain that connection. Maybe sending each other little notes and text messages, even though you're in the same house. It's very easy to have our blinders on and be focused and plowing ahead. When we have kids around us 24 hours a day and we're living in the midst of a pandemic, but finding those little moments to connect us as your couplehood. Even if it's only 15 or 20 minutes or an hour, finding those moments to connect.

What do you think people should know about getting back out into the real world slowly, but also protecting our mental health when all of this is over? 

It's hard to unsee what we've seen and we've been kind of thrown into this trauma situation where we have changed everything about how we view the world. We're literally walking around in masks and standing six feet away from each other. It's changed everything for how we are relating. I mean, I know it's different around the world, but I know where I am we stand six feet apart at the bus stop. We all wear our masks. We have to wear masks outside walking our dogs. It's not going to be that easy to just like snap our fingers and say, 'That's all over. Let's forget about it. 

We are going to live with this shift in how we're viewing the world and how we're engaging with the world. I think that it's going to be unique to each of us, how comfortable we feel journeying back out. Some people might want to keep wearing their masks or be hesitant to hug someone. We're each going to have to take this at our own comfort level. Acknowledging your comfort level and tuning into your values and feelings as to what it feels like to go back to some so-called 'normal'. 

Connect with Bryce Reddy

You can find me on @mombrain.therapist on Instagram and Facebook, and you can always DM me there. And I love having conversations with people and connecting with the big wide world out there. So I'd love to hear from you if you feel so inclined.

Postpartum Mood Challenges and Disorders with Keisha Reaves

Wednesday, June 16, 2021

Postpartum Mood Challenges and Disorders with Keisha Reaves

Keisha Reaves is a PMHC and it's Perinatal Mental Health Certification and it is governed by Postpartum Support International. 


Society expectations in postpartum versus the reality of postpartum?

I think it's a vast difference. Society definitely romanticizes it. It makes it seem like you'll have a baby, you'll breastfeed, and then you'll lose all of your weight. That it's a natural bonding experience. And it's a very magical thing that happens. And you move on with your life and you have this beautiful family that you asked for and is a blessing. That's how society portrays it to be, but the reality of it all is oftentimes doesn't go as expected. 

For a while, it's a lot of trial and error of a bunch of different things on top of sleep deprivation. There's not a lot of discussion about that or how that also affects your mental health. We live in a very binary culture where either things are good or bad. But it can be both- you can feel so blessed, but you can also be very frustrated and feel very stressed. We don't spend enough time talking about this huge traumatic shift that happens and how it affects you mentally, physically, spiritually, and your entire world. 

Most people think of Postpartum Depression as simple as that word, but it actually is a whole spectrum is perinatal mood and anxiety disorders, and more common than not most women suffer the anxiety part of postpartum. Anxiety can be triggered by all of those outside factors, such as not having support, not having a partner, not having family, living in a place that's far, etc. They have the idea of the parent or the mother that they want to be, but all of these things may not allow them to be the image in their head.

So I think one of my biggest missions when we talk about postpartum is to normalize all the things that society has kind of taught us. We expect that these mood challenges can appear any time in that first year after you're having a baby or, when you wean from breastfeeding. It is typical to have experienced postpartum depression or anxiety after miscarriage, because that is a hormonal shift. So if you have experienced loss such as, a stillborn, for example, your body's still in the process as if the baby is physically still here. So you may continue to lactate and your hormones are still going through like the normal process. So you can still have it, but when we talk about those external factors, you're emotionally dealing with a loss. So that's a contributing factor to kind of make you more susceptible more at risk of experiencing a perinatal mood and anxiety disorder because of everything that's going on inside of you hormonally and then also in your day-to-day life.

Subsequent Births

Each birth is different. Every birth is different, but I think just being educated and learning as you go to just be able to just have trial and errors and keep in mind that a lot of the times it sounds like a death sentence for women. Sometimes that's why they don't want to say this is what they're experiencing. However, it's so common. One out of seven women experience it- and it's treatable. It's something that you can be seek help for and be fine and get back to the person that you were before. 

Preparing Yourself

It's very difficult to like prepare yourself for the unknown. I definitely encourage all pregnant women that I work with or pregnant parents to just kind of like expect whatever. Have a birthing plan and have someone that can advocate for you for what you desire, but also go in knowing that a lot of the times things don't go as planned. Like you may think you're going to have a natural birth and then opt to change your mind. No one expects or plans for their child to be in the NICU or to have a traumatic birthing experience. Ultimately I think it's good to seek out therapy or just be able to go to a support group. To have a space to be able to process that so they do not just internalize it and deal with it alone. 

That's so much for your brain to try to process. I always encourage people to have a plan to set up a counseling session with someone afterwards, just for a check-in you may even feel fine. If not a counseling session, a support group- just to be able to check in, hear from other moms, process your story, and just to make sure that you're doing okay. A lot of the time the doctor at your six week check-up is just like adding up postpartum test scores, but not really asking, "okay, so how are you really doing? Or how was it really?" You may not even talk about it with your partner because you're kind of just trying to get by as new parents. So I think that that's a good way to be able to navigate that. 

Oftentimes people are looking for like a red flag symptom. Sometimes it can just be as simple as you just don't feel like yourself. It's been two weeks and something just doesn't feel right. If you feel like the crying spells are continuing past those two weeks, if you feel like your anxiety has become heightened, that you are always worried about your child's safety, your safety- that's always something that's on the forefront of your mind. If you feel like your mood has kind of dropped and the bonding with your baby isn't occurring, if you're having any type of thoughts of wanting to harm yourself, if you feel like you are starting to fixate on a particular behavior, any type of obsessive compulsiveness in how you interact with your baby or day to day- all of those can be kind of red flags. You can ask for somebody to talk to and get some support, to be able to get through that. And a lot of circumstances can happen out of our control, but you're not alone in how you feel and you can get to a better place. 

Postpartum Mood Disorders and Your Partner

Statistics show that if the birthing parent is experiencing any of the perinatal mood and anxiety disorder, that the partner is also experiencing some form of anxiety or depression. Everybody's affected by all of this and your partner is trying to support you. They're also trying to adjust. This is something that's new for them as well. It's good that both parents get counseling or couples counseling as well. There's also new parent groups that people can be able to go to get more resources and to be able to navigate this transition. And it should be said, you don't have to be a birthing parent to go to a new parents group. There are a variety of new parent groups to fit the needs of all new parents. If we are worried about our partners, we are looking for the same exact signs and symptoms: not feeling the joy, weepy/crying, being quick to anger/rage, disconnected, and just kind of not feeling ourselves. Also, know that the anger here is the surface reaction to something that could be deeper. The response could be rooted in depression or anxiety - or just having a difficult time adjusting. Feeling overwhelmed, lack of sleep- so you're irritable. Anger is just the natural reaction outwardly that you're expressing.

Racial Disparities in Postpartum

The media or society often tries to portray racial disparities postpartum as if it's a socioeconomic issue or an educational issue alone. However, a lot of it is just based off of race. Sometimes it can be if you live in a rural area and you can't choose your OB-GYN. So you're just given someone and this person isn't listening to you. There have been studies showing that some doctors that are white may look at their black patients as thinking that they have some sort of super strength to sustain pain longer than others. So then that's how they'll treat their patients versus being able to say, "Oh, something's not right." Or actually just really listening to the patients.

Making sure that your partner, or somebody else in the room with you, will speak up for you. That they can identify the things that are going on and be educated in this process. It's unfortunate that it has to be this way- the idea that we are thinking, "Let's make sure that we go in here and we come out alive and everybody comes home." This is unbelievably unfortunate because other races don't have to go through that. But it's the cards that were unfortunately dealt. And if anything, we can just be adamant about changing that. 

For white women, I think it's more so just being educated. Understanding what your biases are, being able to talk to your peers, being able to work legislatively, identify this as an issue and work through it. If anyone notices anything that's done within an office or within a practitioner, call it out for what it is.  I also think about how America handles maternity leave and the postpartum experience for mothers. There are so many corporations where you have to do short-term disability versus there just being like an actual leave where you get paid a hundred percent of what you were making and you just have that time to adjust. Or for there to be a paternity leave so that your partner or whomever can be able to be home with you and be able to take some time off. All other countries have it right where they can give them a substantial amount of time to be off from work. This is a huge change on you mentally and physically- it is a huge adjustment. It is not something that should be based off of what class you're in for people that can get education or support, but it should be all women who are pregnant/postpartum equally able to get the help that they need. 

Long-term Sustainable Support from our Partners

As long as this baby is here, then the support is indefinite basically. I think that the first thing that can be said from a partner is just like, 'what do you need from me?' On the other hand, it's maybe not always looking for some guidance, but just doing. I've heard from several mothers that they can get frustrated if their partners are asking, 'what do you want me to do?'- when there's chores around the house, there's food that could be cooked, there's laundry that could be done, bottles that could be washed, etc. Not having to have to have that constant guidance and being able to take the lead and initiative. We encourage moms to sleep when the baby sleeps, but moms oftentimes don't want to because they are thinking, 'Oh, the baby is having a three hour stretch- now I can go do laundry and I can go take care of all these other things'. They have a partner that could take that off of their hands. So they don't feel the guilt to have to do that. Then they can really like sleep and heal and be replenished. They can show up and be the parent that they want to be. 

I also feel like oftentimes mothers feel this feeling of losing themselves and becoming a mom and feeling like they're missing the person that they used to be. You have this person that has come into your life that is completely dependent upon you and really needs you. You can just kind of feel like an object that is just providing, providing, providing, and not really pouring into yourself. Their partner can encourage them to not lose that connection to the life that they were versus just being like, 'well, she said she's fine'. The partner can encourage them. Even if mom doesn't say that she wants it - still advocate for her. Make her feel like she deserves it. 

Finding Support Postpartum

It's always good that you get someone that you feel you can trust. Someone that makes you feel heard. And that allows you to be really vulnerable and you can open up and get the help that you need. Most therapists offer a free 15 minute consultation before you have to book an appointment. So that gives you the time to ask those questions, get kind of like a feel of how they are over the phone. Then you can decide to book from there. I've had several clients that have called who have a list of therapists that they're going through kind of interviewing just to figure out who they think may be good for them. 

Also, don't think that it is a luxury that only people who make a certain amount of money can have. A lot of towns have community service boards. A lot of providers offer sliding scale fees where they can do it as low as the person would be able to afford. Some organizations may have an intern that will see someone at a lower fee and that interns is being trained in that specific area. There's different avenues to be able to meet your needs financially. 

You can check out Psychology Today- they have a directory where you can filter it based off of how you are going to pay for therapy. You can also filter by to tele-a-health sessions, gender, race, etc. You can call your insurance provider and ask them if they can be able to provide you with the list. Plus, there's also something that's called the employee assistance program, where the company that you work for typically pays for a certain amount of sessions for you to be able to seek counseling. You can contact your HR department to find out what's the name of your EAP provider. Your employer will never know that you're in counseling. They are two totally separate companies- your employer has already paid for a certain amount of sessions for all of their employees to be able to have counseling at no cost to them. 

Contact Keisha


Email: me@keishareeves.com 

Social Media @pushedthrumom

What You Really Need to Know About Formula and How to Choose the Right One for Your Baby

Wednesday, May 26, 2021


What You Really Need to Know About Formula and How to Choose the Right One for Your Baby


Ignore the labels, it’s all about the ingredients

The red-bolded words “anti-colic remedy” on the front of a formula tub can seem pretty promising when you’re standing in the formula isle of Target after several evenings with a fussy baby. This is exactly what the manufacturer intends when marketing their formula brands to parents. They knowingly get paid by targeting vulnerable new moms who are sleep deprived and desperate. Formula brands will advertise products made specifically for things like reducing spit up and gas or to help improve sleep. But, like most things baby related, it’s not a “one size fits all” solution.

The ingredients and how they react to your baby’s specific dietary and digestives needs are most important to understand when you’re in the process of choosing a formula. And I say process because you are most likely going to need to change formulas at least once or twice, and that is totally okay. I would actually recommend it. But where do you start? Read below for help navigating formula ingredients so you can become a confident formula consumer.

Casein vs. Whey

Pay specific attention the casein and whey protein ratios found in all cow’s milk formula (opposed to a soy based formula). Casein protein will curdle when it meets stomach acid and will sit for longer in the stomach. Whey protein stays in a liquid form and is digested much quicker than casein. If your baby is often constipated, a higher amount of the casein protein may not be the best choice, since it sits in the stomach and isn’t easily digestible. A symptom like spit up could be resolved with a higher whey protein formula because it leaves the stomach faster and won’t linger in the stomach.

Intact Proteins vs. Hydrolyzed Proteins

Intact proteins can be found in the cow’s milk you buy straight from the store. Intact proteins have not been processed or altered in any way. Meaning, nothing has been done to change the shape or size of the protein itself. This is key when thinking about proteins in formula (whey, casein, nonfat milk). For formula’s with full sized, intact proteins (meaning unprocessed and large in shape) we can expect a baby’s digestive system to have to work extra hard at breaking down those proteins. Your baby’s digestive system needs to break them down small enough to be absorbed. This is a lot of work and can cause tummy troubles in your little.

Cow’s milk proteins are often found to be larger than breastmilk proteins. So, in order to make the cow’s milk protein more easily absorbed in formula, companies will break down those proteins in the making of their formula brands. This makes it more comparable to human milk. The process of formula companies breaking down proteins into smaller pieces is called hydrolysis. There is fully hydrolyzed (hypoallergenic formulas) and partially hydrolyzed formula. The larger the protein, the more effort is needed from your baby’s digestive system to breakdown and digest the protein. In order to make your baby more comfortable, consider moving to a smaller sized protein which is less work on your babies digestive system. The protein size found listed on baby formula from largest to smallest is: Fully intact (or just listed as nonfat milk on the ingredients label), partially hydrolyzed, fully hydrolyzed, and free amino acids (found in specialized prescription formulas).

Lactose

At birth, babies are born with low quantities of the enzyme needed to digest lactose since it is not needed in the womb. This enzyme increases in response to increased lactose ingestion once earth side. Lactose is found in high quantities of breastmilk. If your baby is going from breast milk to formula, they should be okay tolerating a higher lactose formula. If your baby is experiencing bouts of diarrhea or painful gas, it could be a reaction to the higher levels of lactose and not having enough enzymes to break it down. It may be wise to try and transition to a lactose free diet for yourself if you are breastfeeding and/or a low-lactose formula. Go slow when increasing lactose exposure in babies to allow time for their enzymes to rebuild.

Other important things to note:

  • - When reading ingredient labels on formula, pay attention to everything listed before the “less than 2%”. Anything after is less likely to be causing symptoms of discomfort in your baby.
  • - Ingredients are listed on labels in order of greatest amount. The first ingredient takes up the most volume, the second listed ingredient is the second largest, etc.
  • - Ratio of proteins in cow’s milk is about 20% whey and 80% casein. Human milk is about 60% whey and 40% casein. Consider this when choosing a formula that best resembles breast milk. Added whey in formula is usually ideal since cow’s milk has much less than human milk.
  • Studies have shown partially hydrolyzed formula can help clear up eczema and other whole body conditions.
  • - Babies born before 40 weeks, or infants who have recently experienced a stomach bug will have less of the lactose enzyme needed to breakdown lactose. Temporality consider a low lactose formula in these cases. (premature baby formula does not have lactose for this reason).
  • - Palm oil could be the cause of your baby’s constipation. Consider formula without palm oil in these cases
  • - Allow for a slow transition when introducing a new formula. A cold turkey change could cause more upset than the ingredients themselves and will give you a false representation of how your baby’s digestive system is handling the new ingredients. When transition from one formula to another, take at least 7-10 days before going 100% to the new formula.
  • - Compare ingredients when choosing a new formula. What was in the original formula that could be causing your baby discomfort and what does the new formula have that could elevate the symptom?
  • - Name brand vs generic, it’s all the same. What is important is the ingredients and how your individualized baby is reacting to those ingredients.

Blog written by Caitlin LeBeau, member of the Tranquility by HeHe doula team.  Referenced from Baby Formula Expert.

America Needs More Black Providers

Wednesday, April 21, 2021

America Needs More Black Providers

Being Black in America is hard, but giving birth while Black in America is downright deadly. The United States of America is one of the richest countries on the planet and has one of the highest rates of maternal mortality..how does that happen? For a country that attracts talent from all over the world, there seems to be a disconnect in the intelligence and the results. Black birthing people in American are three to four times more likely to die due to a pregnancy-related complication than white birthers, and if you are in NYC—that increases your risk even more. 


What Needs to Change?

Well, that’s a 7 layer dip plus some, but a great place to start is increasing access to Black and brown doctors for Black and brown patients. This does not mean that Black and brown people should only be seen by Black and brown doctors, but that they have that as an option if they would like. Because, as it stands now, many Black and brown people in the US do not have that option, even if they wanted. Access to care has been a long standing problem in our country. There are a few new apps that are revolutionizing the way that patients can find care providers that are skilled in culturally competent and sensitive care. 

Black MD Cares - On their website, they state “ Eliminate healthcare disparities by connecting patients with physicians and other healthcare providers that will listen to their patients and care for them at the highest quality regardless of race and ethnicity.” They stated that providers are screened, but did not define what that screening process entailed. You can sign up for free here or download the app in the App Store! https://blackmdcares.com/providers 

Health in Her Hue App - As described on their website, they are “a digital platform connecting Black women to culturally competent healthcare providers, telehealth services, and health content.” Black and brown women have a higher mortality than that of any other race. In America, a large majority of this is due to systemic racism. You can read more about that here.  This app is on the forefront of combatting the lack of access to culturally competent providers! You can download the app in the App Store! 

HUED App - “Diversifying the patient-physician experience” is the first thing you see on their website and I dig it! It’s powerful and calming. You can search for providers by state, insurance coverage, specialty, and in-person/virtual. They are devoted to changing healthcare delivery for Black and Latino patients by 2025! You can read, “Access to (quality) healthcare remains a prevailing problem for people of color. In fact, African Americans and Latinos experience 30 to 40% poorer health outcomes than White Americans,” on their website making their mission very clear. This app is so needed and will change the landscape of care in America! 

Irth App - Their tagline is “Birth, but we dropped the b for bias.” This is a platform to find prenatal, birth, postpartum and pediatric care providers and reviews! This is key to decreasing the infant mortality rate in Black babies.  On their website, Irth shares that it is “The #1 “Yelp-like” platform for the pregnancy and new motherhood journey, made by and for people of color.“ This is a crucial step in helping decrease the disparities in the current birth culture. 

Ayana App - This app is geared toward connected people of color with mental health professionals of color and culturally competent care.  I just recently started counseling with Better Help and it has been life changing. It was so easy to sign up which I had seen them advertise about, but was skeptical at the actual simplicity of it all. But it’s true. It was literally as easy as ordering something online. I answered a series of questions and had a chance to write a brief intro/what I was looking for, if I wanted, which I happily obliged. You should know I am not new to the idea of therapy. I have gone to therapy several times in my life. I know very well the benefits of mental health support. The general anxiety of life is a lot, but the general anxiety of life in a Black or brown body is so much harder and the mental health care accessible should reflect that. 

How about the bigger picture? Longer term? 

Great question! There is a piece of legislation called The Black Maternal Health Momnibus Act of 2021 that will hopefully begin to close the gaps we currently see in healthcare. It won’t be the final fix we need, but its a wonderful place to begin rebuilding this very, very broken medical care system of ours. So what do you need to know about the Momnibus Act

Congresswoman Lauren Underwood (D-IL), Congresswoman Alma Adams (D-NC), Senator Cory Booker (D-NJ) have created a caucus to combat the harrowing stats facing our birthers of color. Lauren Underwood is a Registered Nurse and knows more than anyone how devastating it can be to birth while Black in the US. 

This Momnibus collects 9 original bills, adds 3 additional bills, and proposes 12 accumulative ways that congressional leadership can help protect pregnant women and new moms, specifically people of color. It also promotes continuous coverage for 12-months postpartum by medicaid. 


Here are the things they are committing to: 
  • - Make critical investments in social determinants of health that influence maternal health outcomes, like housing, transportation, and nutrition. 
  • - Provide funding to community-based organizations that are working to improve maternal health outcomes and promote equity. 
  • - Comprehensively study the unique maternal health risks facing pregnant and postpartum veterans and support VA maternity care coordination programs. 
  • - Grow and diversify the perinatal workforce to ensure that every mom in America receives culturally congruent maternity care and support. 
  • - Improve data collection processes and quality measures to better understand the causes of the maternal health crisis in the United States and inform solutions to address it. 
  • - Support moms with maternal mental health conditions and substance use disorders. 
  • - Improve maternal health care and support for incarcerated moms. 
  • - Invest in digital tools like telehealth to improve maternal health outcomes in underserved areas. 
  • - Promote innovative payment models to incentivize high-quality maternity care and non-clinical perinatal support. 
  • - Invest in federal programs to address the unique risks for and effects of COVID-19 during and after pregnancy and to advance respectful maternity care in future public health emergencies. 
  • - Invest in community-based initiatives to reduce levels of and exposure to climate change-related risks for moms and babies. 
  • - Promote maternal vaccinations to protect the health and safety of moms and babies. 

Ready to take action? 

The Momnibus Act website has a few actionable steps you can take to get involved and help push this forward! 

You can: 
  • Reach out to your Members of Congress in the House of Representatives and the Senate to voice your support for this piece of legislation. Ask them support it and inquire about their plans to help close the disparities currently crippling women’s health. You can look up your Representative in the in the U.S. House of Representatives here and you can find information about your Senators here
  • Share posts like this on social media! Help your friends and family know what’s goings on in our healthcare. Momnibus provides a few templates for you, you can find those here
  • Connect with community-based organizations who are making local change and donate to organizations that are leading the fight nationally. You can find the organizations that we support here
  • Follow Black Maternal Health Caucus on social media to stay up to date on the latest news surrounding The Momnibus Act of 2021.

An Inside look at Obstetrical Violence

Wednesday, March 31, 2021

An Inside look at Obstetrical Violence

(Derived from a podcast conversation with Tranquility By HeHe team members HeHe Stewart and Caitlin LeBeau in Episode 136 of The Birth Lounge Podcast, find it here!)

Have you ever heard the term “obstetrical violence” and wondered what it meant? Or maybe you envisioned this blatant act of disrespect or an assault of sorts. These are both examples of obstetrical violence, but there is another side to it, too. A sneaky side. We're going to share a few instances of medical manipulation in the birth room. Not always aggressive, not violent. And that is a tactic- they are trying to get you to do what they want. Which is so hard to say because we are conditioned to trust our doctors, we want to trust our doctors.

This isn’t about batting heads- this is about questioning, looking into research/evidence, looking into policies so you know if they are being influenced/pressured. Have that open communication if you can. You can say, 'That's not, evidence-based, I'm really only interested in evidence-based research and policy. If the hospital policy prevents you from giving me like the most current stuff, I would just appreciate you giving me that heads up. I understand you can't suggest that, but I would love if you would just let me know the last year that the policies of the hospital have been revisited.'

This should feel like a two sided convo. You can push back a little. they should be able to give you answers- and if they don’t you need to do that research on your own before game time.

Bait and Switch

But a bait and switch- which basically means, you earned my trust and then you tricked me. So heartbreaking because during the pregnancy, they were amazing. This one that we last had where the mom was overdue and went into an appointment and they basically had told her, 'You know, we're going to have to do an induction because your baby has passed 40 weeks and 2 days'. Which we know average first time mothers deliver most typically between 40-41 weeks.

So they went home, they did the research. They decided to try a natural induction method instead over the weekend first. After the weekend, they gave their doctor provider a call and the doctor said, 'Oh, we don't have any beds until Tuesday in the evening.'

What is that? If I NEEDED an induction four days ago and now I'm comfortable coming in for a medical induction, but your pushing it a day and plus? How does that make sense? I just can't handle being told that you need to have your baby without having gotten out of that window of where we know a first time baby is likely to be born around 40 plus 5. And then you have providers calling it a late baby or an overdue baby. And that is instilling fear in these parents, especially when you're at the end of pregnancy.

'This is a long labor...'

We had a birth recently that was going well at about 16 hours- we had just hit the mark where her provider said the baby could 'come at anytime'. Then shift change at the hospital happened. The nurse we we working with literally said to us, 'Be careful with the doctor coming on call.' How horrifying that a nurse felt compelled to warn us about the doctor that was coming into our space.

The doctor on-call comes in, says, 'Let's get you prep for a C-section.' This was the first time we were seeing the doctors face. They hadn't introduced themselves. Also, and most importantly, this is the first time we're hearing these words. You haven't even checked in with us on what is happening, what our birth goals are, how long, how long we've been in labor. It had been 16 hours. What happened? The fear that that doctor brought in the room and then said, 'Your labor is so long. I don't think this is going to happen for you, kiddo.' I feel nauseous thinking about those words. That is so rude and disrespectful.

16 hours is a long time, but is it a long time in birth? Not really, not at all. It's not even the average amount of time for a first time mother. But then you have a doctor coming in a doctor who sees this every day say, 'This labor has really taken a long time'. And birthing people start to question themselves.

If there isn’t an immediate emergency, you should be able to think things through. Catch that manipulation when it's happening and push back on it. Ask the questions that you should. Your doctors aren't always going to tell you everything unless you ask. It's all in your approach of how you say this. Don't try and catch them tripping up in a lie, simply say something like, Oh, I was thinking X, Y, and Z, because the research I had seen showed X, Y, and Z' or 'I was actually wondering if X, Y, and Z would be an option. I know you didn't mention it. But I was wondering if we could explore that or I have some questions if I might be able to use that or not'. Your approach is not you against them. That's not what this is meant to suggest.


But what can you do?

Your job is to take this preparation, evidence based knowledge, this idea of shared decision making and put it in your toolbox. Make sure it feels aligned with you. Make sure that it's evidence-based and then go for it. Take the time and come up with a couple of questions that you have. Even one question can spiral into a conversation or your doctor giving you more information. This information could shape the path of your birth.

You can go in being the calmest person ever to the hospital, and then you go in and you hear these medical providers talking nonsense around you, or just hyping you up in the wrong ways. You just completely forget about what was happening 10 seconds before that. You're just focused on what your nurses and doctors are doing or saying. Even them using bad language around you and not being mindful of the words they are using. It doesn't have to be intentional. Just be aware of this when you go into the hospital. It can be startling and alarming. 

You can also use this as an opportunity to remind your medical team to take conversations outside or to ask them not to have conversations over/around you. Sometimes all your doctors or nurses need is a reminder that they are negatively impacting the birthing persons space with their words. You can also ask for a new nurse or doctor when you feel like they are negatively impacting your birth.

If a doctor does comes barging in and says, 'Let's go, you know, time for a c-section'. You can say, 'We haven't decided right now if we want a C-section. We would actually like a few minutes'. And you know, if it's an emergency, they will be very upfront with you and let you know that there isn't a few minutes to spare. It's rarely an emergency C-section, but we don't have a word for non-emergency sections. We have scheduled C-sections and then we have emergency C-sections. We don't have any sort of like unplanned terminology. This was just unplanned. We gave it a try and it didn't work.

Birth as a Business

So if we want to look at this as a business, birth is a business. If you haven't seen that documentary, you1000% should. It is called 'The Business of Being Born'. It's will open your eyes to how much birthing people can be cash cows for hospitals. We can go from bringing in like a little bit of income to like being a major source of income depending on choices and pressures put on birthing people.

And you have to think for the typical hospital labor you're looking at less than $10,000. For a C-section, you're looking at $30,000 to $55,000. That's how we go from being a small stream of income to a main source of income for a hospital.

I don't want you to feel fearful of this. I want you to do your own research. There are things that are good for you to know. There are a ton of things that you can read, listen to, or watch to educate yourself on the business side of birth, which is important to know as a consumer, because it actually does impact you. It impacts their bottom line, but it impacts you your body and your life after this. It's not meant to be scary. It actually gives you a lot of power if you'll dive into it in the correct way.


Don’t forget to check out our newest adventure The Birth Lounge, listen in to The Birth Lounge Podcast, and follow us on Instagram at @tranquilitybyhehe and @the.birth.lounge!

Food First Nutrition with Ryan Kipping

Wednesday, March 24, 2021

Food First Nutrition with Ryan Kipping


Today Ryann Kipping, a Registered Dietitian Nutritionist, Certified Lactation Educator, and Author of The Feel-Good Pregnancy Cookbook is here to break down how to get the majority of your crucial vitamins and minerals from food first! So many foods can be solutions to problems that pop up in pregnancy--constipation, nausea, heartburn. Ryann is sharing how to find the perfect prenatal, how to spot 3rd party testing, and how to identify trustworthy brands!

Diet culture is crazy right now. It's hard enough to eat when you aren't pregnant to figure out what to eat when you aren't pregnant. Then when you throw a pregnancy in the mix there's like so much confusion. There's so many do's and don'ts floating around. One source says something and another source says something completely different. That is why I'm here- to clear that confusion and make you feel confident. Not only that, but just so you have informed decisions, because like I always say, I'm not trying to steer you one way or the other. I'm just trying to give you the science and give you the information. So you can make the best choice for you and your pregnancy, because with all these diets floating around out there, ultimately nutrition should be individualized. You shouldn't be following the exact same diet as your neighbor, right? We are all so unique and we all have different health backgrounds and nutrition concerns.

So at the end of the day, it's definitely going to be individualized to you. With that being said, of course, during pregnancy, there are nutrients that are super important and things we do want to focus on. So to start us off, I think that one nutrient that most people immediately think of when they think of pregnancy is folate or folic acid, which are commonly used interchangeably. We're talking about the same nutrient. They're just different forms of that nutrient.

Folate vs. Folic Acid

So folate is the kind that's naturally found in food and folic acid is the synthetic form. So folic acid is generally the more common type found in supplements. It's also the kind that food is fortified with. So whenever you see these like flour/grain based products that are fortified - it is with folic acid. So that means it wasn't naturally there. They companies and organizations actually took folic acid and put it in that food.

I like to give a little background here, because the reason they did that was that there was a lot of neural babies being born with neural tube defects. Folate is the nutrient that helps close the neural tube. So it's super important for baby's brain and spinal cord development. So they companies decided to fortify the foods that people eat the most with folic acid and we'll fix this issue- and they did. So we saw a major decline in neural tube defects, which was great. But to me, I'm thinking, is it smart to be promoting the increased intake of processed refined grains essentially? And I'm not saying we can not eat those things. Just to pull back a little bit. I'm not saying we can't include those. We just want to include them within moderation. So all that being said, my focus and my recommendation is to put the majority of our focus on natural sources of foliage.

So that's the folate that's naturally there in dark leafy, green vegetables, avocados, asparagus, citrus, fruits, nuts, seeds, eggs. There's a lot of ways you can get natural folate. So that's the kind I say, we spend the majority of our time focusing on and that's also the kind we should look for in supplements too. We want to pick a supplement that has folate versus folic acid because that's what the body prefers and it's absorbed better in the body.

Choline

So another nutrient we want to talk about is choline. Choline has been compared to folate and it's important, although it is a new, relatively new nutrient in the science world. So not many people talk about it and not many providers even know that it's so important. They haven't seen the research out there, especially, doctors that went to school in like the sixties before it was like even discovered, right?

So choline has been compared in pregnancy to folate. It's important in brain and spinal cord development. It's mostly found in eggs, specifically in the yolks. So I always like to say, make sure you eat the yolk whenever you're eating eggs, because a majority of the nutrients are in the yolk.

Iron

Iron is obviously super important too. I think iron is the second nutrient people think of when we think of what nutrients are important for pregnancy, because your risk of iron deficiency is extremely likely because your blood volume is continuing to increase as you get bigger and bigger. As baby grows bigger and bigger- iron is super important for overall development of baby. Also, just for you to have energy, because pregnancy is so hard and you experience fatigue a lot in the first trimester. And I mean, throughout the whole pregnancy, but iron is a nutrient that's super important to make sure you're maintaining your energy levels. Super important, if you are feeling super fatigued to get your iron levels tested. Cause that's definitely a red flag.

Testing is so important because not everyone needs iron supplements, sometimes providers will just put blanket recommendation out there. They'll just like list off nutrients. When in reality it should be individualized to you. And if you don't need to supplement with iron, you shouldn't. It can cause stomach issues and constipation and things like that. So if you don't need to supplement with iron, if your levels are looking good, then we don't need to put you through that. So test, if you can. If your iron levels are looking good then I would honestly recommend finding a prenatal without iron because for lot of people, it does cause constipation and things like that.

There's different forms of iron, too. So if you are someone who does need iron try different forms of iron. Try food first, I'm totally a food first dietician. So the best way to increase your iron levels is by through food. So definitely work on increasing high iron foods. There's heme iron and there's non-heme iron. Heme iron is the kind that's better absorbed by our bodies and that's the kind that's found in animal products. So that's kind of where we want to put our majority focus is getting iron from animal products. Ideally from red meat, chicken, those kinds of things. You can include plant sources too, those aren't going to be like the best to increase your levels. Spinach is one of the best sources of iron from plants. Pumpkin seeds are great too. My final tip is to pair them with some source of vitamin C, especially with the non-heme sources because vitamin C will enhance iron absorption.

How much should we be eating to know we're getting enough from food?

So I say food first because ideally we want to strive to meet our nutrient needs through food. Then use supplements as an insurance policy that we're getting everything that we need. So a prenatal vitamin is not going to provide everything you need. It just doesn't. And it won't. So you have to think about your food. There are certain times in life that I think it's necessary to supplement and pregnancy is one of those times because your needs are heightened.?Your needs are higher for nutrients than they will likely ever be in your life during pregnancy and breastfeeding. Your needs are so high, so it can be challenging to meet those nutrient needs, especially if you're like a smaller person and you don't eat that many calories.

So if you are eating around 1600 calories, you won't be able to meet your nutrient needs because you're just simply not eating enough food. So in that case you definitely need to be taking a well-rounded prenatal vitamin. I have worked with people that don't want to take anything that they don't want to supplement with anything. I say maybe we can just take a few like individual nutrients to make sure you're good to go, but yeah, if you don't want to supplement- you're going to have to be really on top of your planning.

You're just going to have to be able to run through the nutrients in your head and look at your days and plan them out. You can't just like wing it and go by the fly. I think we should all do a little bit of planning, even if we are taking a prenatal vitamin, but pregnancy is hard too, right? There's so many ups and downs. There's morning sickness, heartburn, fatigue. There's so many things that you're going to go through that make it challenging to stay on top of your nutrition. We just want to make sure we're doing the best we can.

How Do we Know What Prenatal to Pick?

So I always say, I wish that people spent the amount of time and money on their nutrition and food and planning versus the time they spend on finding supplements and spending money on supplements, because truly the food you eat is way more important.

So just to preface it with that, however, we do want to find a supplement that is quality and that is going to work. The number one thing to look for is if the brand is third-party tested. So essentially that means they've paid a third party to take their supplement, run it through tests, to make sure that it is free of certain harmful things. That what they're saying is in there, if they're saying so much of a certain vitamin in there, that that is actually true.

It's pretty apparent if this is something that they have done. They usually have stickers that will say, 'third-party tested' on the bottle. If you're doing online research, usually it's clear on their website. That's definitely a good way to know if they're a quality supplement brand.

You definitely want to do your due diligence. People are always asking, which one do you recommend? Which one do you recommend? And I never bulk recommend one, because that really doesn't make any sense. It should be individualized. There's so many factors that come into play, but of course always third-party testing.

Nausea and Prenatals

If you think it's your prenatal vitamin that's causing the nausea, I would definitely say changing your prenatal vitamin and trying another. You can also try taking it with food, because that can absolutely help. There are also gummy or powdered versions of prenatal vitamins. If you have one that's a large pill, you can absolutely cut it and break it up to see if that helps too.

So there's just a lot of options when it comes to that. Again, considering what is in your prenatal- iron could be causing some nausea too. So do you need iron? We can look at that. And then nutrients that specifically help with nausea. Magnesium and vitamin B6 can definitely help. I'm going to bring up the point that we do want to try food first. We want to try more natural options. So we want to try increasing our food intake of high magnesium foods, high B6 foods. We want to try ginger, ginger tea or anything like that smells like lemon, eucalyptus, or lavender. If none of those things are working, we can talk about supplements. Your doctor might also want to talk about medications like Zofran and things like that for nausea.

There are so many options out there to help you manage morning sickness and nausea. So try everything. And you never know what might work. A lot of times too, women will say the only thing they can tolerate is carbs. You want to be able to eat something. Some calories is better than nothing at all. But I usually say is try to follow them up after with some source of protein. So, if you can eat a piece of plain toast and then maybe 30 minutes later, have some nuts, a piece of chicken, or have a piece of cheese. Something that has protein and fats in it. So you're getting some other nutrients that will be better to manage your blood sugar, all of those types of things.

Constipation in Pregnancy

As far as constipation goes, the two things we want to focus on are fiber and fluid. So increasing fiber foods, like cooked vegetables. Vegetables in general, but cooked is usually more advantageous because women often experience bloating and gas in pregnancy. So cooking vegetables can help with that. Fruits and vegetables are really high in fiber. Apples, brussel sprouts, lentils, chia seeds. Chia seeds are unique in that they can actually help with diarrhea and with constipation. You do want to make sure anytime you're increasing your fiber, you also increase fluids because it could make you more constipated.

What about Heartburn in Pregnancy?

One of the best things I say is walking after a meal, I know that's not super food related, but walking gets your digestion going. So the worst thing you can do after a meal is lie down. So don't lay down on the couch after a meal, because you're only like helping gravity pull that acid back up your esophagus. So at the least you want to sit up straight on the couch and work on your posture to make sure digestion is moving. But best case scenario, you go for like a 10 to 20 minute walk after you eat.

So you can eat small frequent meals throughout the day can really help your body is having a hard time, digesting it all. Trigger foods is another and super important tip. A lot of people have that one or two food, food groups, or specific foods that will trigger it. A lot of times it's tomatoes because they're super acidic. So it's important to find what your trigger food is. Sometimes dairy will help, but some people say that dairy makes their heartburn worse. So again, it's individualized and you just kind of have to figure out what helps your heartburn and what are your triggers. That way you can avoid that food or minimize it.

Healthy Fats

Fats are super important and fats do not correlate to the fat on your body. So I think that that's definitely something we want to bust as a myth. Your baby's brain is like 60% fat and it's being made from scratch. So you definitely need healthy fats. And then to that point as well, your need for fat soluble vitamins increases during pregnancy. So you have to eat fat for your body to absorb those vitamins. So it's super important that you have healthy fats in your diet.

So very specifically in oils like cooking oils, we want to do our best to avoid processed vegetable oils. Instead use like avocado oil, extra virgin olive oil, real butter, coconut oil is fine. Also nuts and seeds, avocados, olives, the fats that are naturally found in meats, fatty types of fish. Definitely lots of healthy fat options. We also don't need to limit our fat in dairy. I actually recommend full fat dairy during pregnancy.

If you're lactose intolerant and you can't eat dairy at all, that's okay. Dairy is a huge source of calcium, but there's plenty other foods that have calcium. You just have to kind of be a little more cognizant of like where your calcium is coming from.

Most milk alternatives can all generally fit in your prenatal diet. You just want to be aware of what nutrients you're missing and where you're getting those nutrients. Because most of those milks don't have protein like cow's milk does. So those aren't going to be a source of protein for you. They aren't going to be a source of B vitamins like cows milk is they aren't going to be a source of B12. So if you are choosing like a plant-based milk, we do want to try to pick one that is fortified with some nutrients. Dairy can be a source of vitamin D one of the only sources of vitamin D, because vitamin D is so hard to get from food. So that's another nutrient to think about. Dairy as a major source of iodine. So there are definitely nutrients you want to kind of think about if you are not including dairy in your diet at all.

Looking for more? You can find Ryan at https://www.theprenatalnutritionist.com/.  She has also created The Prenatal Nutrition Library, which gives you clear answers to guide you through a healthy, feel-good pregnancy using food first.  She has also shared her Recommended Grocery List! You definitely want to check out Ryann's resources if you are trying to conceive, pregnant, or even postpartum as you try to balance your nutritional needs! 

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