Sleep Routines with Anna McMillian

Wednesday, November 17, 2021

Sleep Routines with Anna McMillian

Sleep Routines vs. Sleep Training

When we are talking about sleep routine vs. sleep training we are discussing totally different choices. You've got to look at the foundations because if you are going to sleep train and you don't have your foundations sorted- it's not going to work anyway. There are things that need to be in place regardless of how a child gets to sleep. So sleep training is looking at how the child is getting to sleep. This is what I need to go to bed. For an adult that might be like turning off the lights, locking the front door, brushing your teeth. When we look at a child's sleep routines and health what we're looking to do is actually set up healthy habits.

If you think about the habits that are gonna last a lifetime, those are the things that we really want to concentrate on as a newborn. We're looking at how we are communicating with our baby? How are they communicating with us? They're actually trying to tell us an awful lot. Babies are born with 12 to 15 different cries. And if we answer the same time with everything, they actually narrow that down. We want to have our baby feel like they're able to communicate what is happening to us. We're able to listen to them and then those communication tracks really go together. So if they signal that they are tired, you're then having a routine that you're able to communicate back to them.

It's opening up those communication lines. It's looking at those sleep hygiene hygiene. And also setting up those realistic expectations, even for yourself as a parent, what is healthy sleep hygiene? The bedtime routine having pajamas is a good sleep signal for a baby to know it's sleep time. For routines we're looking at those things that help a child communicate, feel safe, and that signal that sleep is coming. When we look at sleep training we're helping them shape how they want to get to sleep. We want to make sure that they feel comforted and safe.When we have really good foundations the baby feels competent and safe in expressing their need for sleep.

The need for sleep training doesn't always arise because we're able to make sure that everything is in line. When a baby has great communication skills you have a jiving between parent and baby from the beginning where a baby is able to cue their need for sleep and the parent is able to respond appropriately to the sleep cue to support the baby.

What to do if you already have bad habits in place?

There's no reason why you can't adjust your sleep routines that are going to be really healthy shifts that are not, that are not kind of brutal. It doesn't need to be like, cry it out and really tough. Yeah. It needs to be focused and strategic, but that's why we have healthy sleep routines right from the beginning. And that's why when you change, sleep for babies, it needs to be, you need to have a plan about how you're going to do it and we need to do it strategically and consistently. So that then baby is like, I know when mom or dad makes a change that this is like, I can trust that I can lean into it.

Then they're able to lean into those sleep skills that they already have, because there's no such thing as like a good or a bad sleeper. There's no such thing because to be honest, 25-50% is genetic. That means 50-75% is learned behavior. So that is the portion that we need to focus on. This is how we can set them up for success and really do it in a way that your child's feeling confident and safe.

Why your baby needs routines

  • - They need to start understanding day and night. The way they do that is by having day and night routines that differentiate the two.
    • - Ex. It is nighttime and when it is night we: do a bath, we do our pajamas, we do a feed and we also do a dark room.
  • - They need to have quality awake time during the day. And this is different during the night. We want to have these routines because they need to understand how to know that their body is tired. It is super stimulating for them to be awake in the early weeks of life and we need to help direct them to sleep to avoid overtired and over-stimulated babies. This helps them to work with sleep pressure instead of against it when they are over exhausted.
  • - We need to communicate with our babies. By consistently using these routines, your baby will know when it is bedtime after a few weeks exactly how they know it is time to feed when you grab the bottle, grab a nursing pillow, etc. These routines help you to communicate with your baby to support their expectations of what is happening.
  • - Routines will help you to support a healthy sleep foundation for your child and allow you to spend less time as a new parent stressed about sleep.

Follow along with Anna for more tips! Check out Little Winks Sleep Courses here and follow along on Instagram here!

How an Active Pregnancy Fosters an Enjoyable Pregnancy

Wednesday, November 3, 2021

How an Active Pregnancy Fosters an Enjoyable Pregnancy

As a physical therapist and mother of two, I am passionate about helping other women have an enjoyable pregnancy. As a society, we need to take better care of our mothers. We are the caregivers of the world and should be treated as such. Growing and birthing a human being is a freaking super power. I’m here to empower you to enjoy this monumental time in your life.

Being pregnant is hard work.
Pregnancy can be draining emotionally and physically. Our bodies are adapting to different hormones and a different weight distribution. Our sleeping patterns are changing and our stress levels may be rising. You might be taking care of other children or working outside the home. So, how do we get through nine months of growing a baby and a changing body while still feeling well mentally and physically?

Pain and leakage--common but no longer the standard!
Low back pain, pelvic pain, hip pain, and urinary incontinence are all common symptoms during pregnancy, but are actually very treatable symptoms. They should not be accepted as something you have to live with during pregnancy. A physical therapist who specializes in treating women during pregnancy can help you resolve pain and/or urinary leakage. Specific exercises, positions, postures, and techniques can prevent and alleviate these symptoms. Sometimes it’s an easy fix, like using an SIJ belt or belly support, using pillows between your knees at night, or practicing good mechanics during your daily activities. It’s important to address your pain and leakage during pregnancy. If left untreated, these symptoms can persist throughout pregnancy, postpartum, and in future pregnancies. Living with pain can lead to poor sleep, depression, and a decreased quality of life. Don’t accept these symptoms as just being “part of pregnancy”, a physical therapist can help you!

Exercise is medicine.
Before starting an exercise routine, you first should clear this with your physician. Once cleared by a doctor, starting and maintaining an exercise program is beneficial for the health of both mom and baby. Regular exercise during pregnancy leads to less pain, improved mental wellbeing, increased energy, improved sleep, decreased constipation, and a lower risk for excessive weight gain. Participating in regular physical activity decreases your risk for gestational diabetes and c-section. It is also associated with shortened labor and faster recovery. If prior to pregnancy you were running or exercising at a higher intensity, I encourage you to continue these activities (if you want to) if your physician has cleared you to do so. Symptoms like pain, urine leakage, or a “heaviness” feeling in the pelvis or rectum warrant a decrease in the intensity of the exercise. If you’re experiencing any of the following, you should contact your doctor immediately: bleeding or fluid leaking, severe abdominal cramping, dizziness, or headaches. I’m a firm believer that we know our bodies best. If you listen to your body and modify exercise when needed, it is safe and healthy. I love problem solving with clients to find ways to move more optimally so that you can maintain your current level of fitness during pregnancy.

Every Mother is an Athlete.
As a lifelong athlete and marathoner I can tell you that labor and delivery was the most intense workout of my life. It requires endurance, strength, tolerance to discomfort, mindfulness, and a degree of flexibility. If we train for sports, marathons, and even 5Ks, why don’t we train for labor and delivery? Especially if you’re planning for an unmedicated birth, we have to start training for this event. Having experienced two child births along with my expert level knowledge and education, I’m blessed to be in a perfect position to help you train for the “marathon” of labor and delivery.

Want to start an exercise program?
I’d love to share a week by week program that will keep you active and feeling good throughout your pregnancy.  Click here and use the code 'TBL' for my free labor and delivery eBook! Congratulations and I can’t wait to meet you! Postpartum plans are also available for after delivery! If you’d like more information regarding fitness and wellness during pregnancy, visit or contact me at 

 Hello! My name is Katie Ruebush and I am a women's health physical therapist, farm wife, and boy mom dedicated to helping women throughout their lifespan live healthy, active lifestyles. I am particularly passionate about caring for and pampering the pregnant and postpartum woman and helping new moms embrace a new body and a new way of life. I love empowering women to take control of their pelvic health and reach their goals through education and expert level care. I look forward to meeting you!

Follow along with Katie here:

The Issue with Hospital Provided Doulas

Wednesday, October 13, 2021

The Issue with Hospital Provided Doulas

You’re sitting at a friend's table. Your ever expanding belly is, of course, the topic of conversation. “I’m thinking about hiring a doula”, you tell your friend. In the background the sounds of her own children serve as an unending, but joyful soundtrack. “OH!” she replies, “The hospital you’re delivering at provides a doula for anyone wanting them. They’re affordable, too. Maybe even free!”. Perfect, you think. Now, you can finally stop worrying about the money aspect. “Really? I’m impressed the hospital is providing them. That makes me feel so safe”, you tell your friend. “Isn’t it amazing!?”. You agree.

Pause a moment here and let’s consider a few things: Is it amazing? Or could it be problematic?

Let’s break down the conflict of interest before you grab the phone and hire that hospital provided doula. 

The Ethical Issue

The presence of a doula is supposed to ensure an unbiased, evidence based birth environment. When you hire a doula they work for you and you alone, but can this be true with hospital provided doulas? 

Honestly, no. 

Hospital doulas are often available for a small fee, or entirely free. This is because the hospital is paying them as a member of their staff, training them to follow hospital protocols, and as they receive this training they also learn their “DOs and DON’Ts”. Most likely those do’s and don'ts are vastly different from the ones followed by an independent doula. Hospital doulas don’t work for you and you alone. They work for the hospital. How often have you seen your labor and delivery staff stand up to your Dr. or call them out for practicing in a non evidence based way? It’s pretty rare, huh? This is the exact issue with hospital provided doulas. It is our job to follow your wishes as closely as safely possible and ensure that everything that goes on is 1.Consensual and 2. Appropriate care. How can hospital doulas truly do that when standing up for those things could get them fired, throw their family into a financial bind, and disrupt their career? Plain and simple- They can’t.

The Moral Issue

A doula is an extra set of eyes. A deeply-trained and highly-aware set of eyes that is watching and analyzing the care you receive as you labor and birth. We’re watching the pitocin level to make sure it isn’t being turned up too quickly (or without your consent), we’re watching for bags of Pitocin and making sure they aren't hung on your IV without your knowledge. We’re informing you that you don’t have to consent to a cervical check, we’re making sure you’re being asked before your body is touched. We are in all corners of the room, hearing the medical jargon and translating it within moments so that we can relay it to you in easy, digestible language. Our goal is ALWAYS to work in collaboration with your medical providers, but there are times when medical providers make moves that are not what you wish for, or in some cases not evidence-based suggestions for you and baby. In those situations we speak up. We have no obligation to your provider, hospital, nurses, etc… Our one and only job is to support you, advocate for you, and create an environment where you are in the driver’s seat of your birth. 

But what happens if your doula DOES have obligations to your provider, hospital, and nurses? Are they going to be as quick to speak up? Are they going to speak up at all? It’s unlikely. Speaking up for you, even when they 100% know they should, may get them in trouble. 

It might even cost them their job.

The Money Issue

While many doulas take HSA/FSA dollars, insurance companies don’t want to pay fair rates to provide their customers with doula support. Which means doula support isn’t accessible to parents with lower incomes, no HSA accounts, or parents who live paycheck to paycheck. Here is where the hospital swoops in to fill the gap and provide their patients with doulas that are paid through the hospital instead of paid privately. How wonderful that the hospital is providing this support! Sure, it looks good to the community. It looks so good, in fact, that it draws families in. 

Mother’s from all over the region are flocking to this hospital, and with them comes copious amounts of cash flow. Hospital doulas are not employed for your benefit--their position is a genius marketing ploy that fills the hospital’s pockets and fills you with a false sense of security. 

The Issue of Compliance

As we should all know by now, doctors, nurses, and other members of L&D staff are bound by hospital policies that are often not evidence based and/or overly restrictive towards physiological birth. 

Guess what! The hospital provided doula is no different. Here’s the best kept secret, hospital policy does not govern the patient body. Only consent does that. The hospital doesn’t want you to know that, of course, but one of the things I encourage my clients to do is get comfortable saying the phrase (or some iteration of) “My consent overrules your policy, and I do not consent to this”. I encourage my clients to get comfortable with it because my loyalty is to them and their wellbeing only. My wish is for them to bring their baby earthside safely and beautifully in charge. 

Independent doulas are not bound to policies and protocols and therefore they are not complicit in the routine dehumanization of mothers that may, and will at some point, take place on every labor and delivery ward. The doulas that work within these wards are bound by a contract. This contract outlines what they can and cannot do for their clients, and herein lies the root of the entire issue. Sure, epidural use drops slightly and breastfeeding rates go up marginally when hospital provided doulas are present for birth, but the fact of the matter is that hospital doulas aren’t empowering you to have the birth you want, they’re preparing you to give birth in a convenient and policy abiding fashion.

So, what control do you have?

Hire an independent doula. This may be a wonderful question for when you are interviewing for birth support-- “Do you work for any hospital system or only for private clients?” Any person you are hiring should be honest and transparent with you about any conflicts of interests. 

Now, this places the financial burden of hiring a doula on the parents, so we brainstormed a few ways to help fund your birth support:

  • - Ask folks to put into a doula fund instead of buying a baby gift/baby shower gift
  • - Find a doula who offers payment plans
  • - Ask about cash discounts
  • - Find a doula who offers sliding scale pricing
  • - Barter with an offer that you can provide to your doula as exchange for their support
  • - Add it to your baby registry
  • - Ask your doula if they offer gift certificates for friends and family to purchase for you
  • - Reduce the baby gear and ‘extras’ you invest in and instead invest in a doula
  • - Save, Save, Save

The Bottom Line

Hospital provided doulas are almost always in this field for the right reasons, but unwittingly fall victim to the conveyor belt of birth all the same. They don’t take these opportunities to add to the ever growing birth trauma rate, but intentional or not, they are merely a pawn used to give patients enough of a false sense of security that they’ll flock from nearby cities and bring in more money. They’re used as a primer for medicalized birth so that you don’t come in informed, empowered, and aware of your rights. They’re used for good publicity and then bound by bureaucracy that impedes their ability to advocate, speak up, and do their job. 

Tie a person's livelihood to a contract that silences them and you’ll slowly see them become more and more complicit.

This is not a structure crafted to support physiological birth and achieve best clinical outcomes. This is a scheme crafted from hospital board rooms filled with (mostly) men that are more concerned with counting money in their pocket than they are counting the startling rate of trauma and deaths coming out of their labor and delivery wards. You are not a hospital provided doula’s boss.

That boardroom is their boss, and ultimately that is where their loyalty lies. 

How to Get Your Baby to Sleep Through the Night

Wednesday, October 6, 2021

How to Get Your Baby to Sleep Through the Night with Eva Klein

(Taken from The Birth Lounge Podcast with Eva Klein, Certified Sleep Consultant)

So I am a certified infant and child sleep consultant. I help exhausted moms get their little ones consistently sleeping through the night so that they can be functioning humans again. And I got into this business because of my middle child. So, um, I'm a wife and a mom of three. I live in Toronto, Canada and I, my kids are 10, almost eight and almost three. Um, and so it was my middle child that got me into this business because interestingly, I'm actually a lawyer by training. So my previous lifetime, um, which wasn't, which was you about 10 years ago now I was working as a lawyer. I basically finished law school, had my first baby. Um, that first baby was like this unicorn baby that made me look amazing and was just so easy and happy all the time and you know, slept amazingly. And then a couple of years later when I was done law school and got called to the bar and I was working, I had, I gave birth to my second daughter who unlike her older sister, you know, this baby was a very high needs, very difficult. 

I could tell from the second that she was born. When I say the second, I literally mean maybe 20 minutes after she was born. I could just tell that this baby was different. That her temperament was different. She was, you know, fussier. She was crankier. I have this image of my husband. It was probably four o'clock in the morning and he's walking around the postpartum ward, holding this baby, trying to get her to calm down. And, uh, that was never the case with my older one. And so naturally she did not sleep. She was waking me every 90 minutes all night long. You know, when she was four or five minutes old, I was so exhausted. I literally felt like I was going to die. I was not functioning. I could barely cope with life. And I should just mention that I was on maternity leave. 

I mean, I don't mean to rub this in the faces, any of your American listeners, but I mean, here in Canada, we get 12 months of maternity leave. Actually. Now it's technically you can take up to 18 months. Um, so I really, I hate mentioning this on an American broadcast because they feel so terrible. My sister lives in New York. I should just manage it. And she had her first baby about three months ago and she's going back to work soon and she's literally beside herself. So I, I know how hard it is, but it's relevant to the story here and that I was on maternity leave. I was dying from the exhaustion. I had no choice, but to open up the sleep books and figure out what to do. And I managed to make the situation a little bit better on my own, which gave me some clarity. 

What does 'sleeping through the night' REALLY mean?

For my purposes, I do like to use one definition of sleeping through the night and that is baby sleeping 11 to 12 hours uninterrupted. Now, when is a healthy baby able to consistently do that? In my experience, definitely by eight months, but I've definitely seen babies younger than the eight month period be able to pull that off. However, there are just as many babies in that four to seven month mark that might still need that one feed around, let's say 3:00-4:00 AM. So it's definitely a little baby dependent, but I would say for the most part, if a mom comes to me with a five month old baby who is waking her up multiple times a night to eat, we can absolutely get that baby sleeping significantly better than the way that baby is right now. I can tell you for a fact that when you get a baby who is waking up four times a night down to one night waking, it is a game changer when it comes to mom's mental health and ability to function on a day to day basis. 

The number one thing you want to make sure is that your little one is never over-tired.  Over tiredness is a massive sleep stealer when it comes to babies of all ages, right? It's going to cause them to fight sleep, fight bedtime, wake up more  unnecessarily at night, and give you short naps. It can also cause early rising as well. So from day one, I suggest making sure that your baby isn't up for too long throughout the day. That's really the key here is to be looking at their periods of wakefulness. 

How long can your little one be up for before they need to go back to sleep for newborns? The answer is not very long.  It is really important to stay on top of the appropriate wake windows for their age.  Most importantly, understanding that what goes on during the day directly impacts what happens at night is really, really crucial. 

As the day goes on, naps tend to get trickier and trickier for these babies because external homeostatic sleep pressure gets weaker. Basically there is this external force that basically just describes this buildup of sleep that helps babies fall asleep when they need to fall asleep. But as the day goes on, when that external sleep pressure gets weaker, that means that the baby is going to rely more and more on you to help them fall asleep. And that's okay because they're really little- and they may need your help here.  That may mean your last nap of the day before bed time is on a parent, in a stroller, or in a carrier.

Sleep Regression

So let's chat about the four month tip that I have for parents starts back in the early newborn days: to try to get your little baby down sort of awake half awake, drowsy, but awake. In other words, not completely asleep, maybe once a day. The reason for that is because it's a very important skillset that your little one is going to take with them throughout the next months and years when they are learning how to sleep like a champ.  When babies reach the 'regression' stage, what happens is that their sleep cycles undergo a permanent neurological change where they are now cycling in and out of deep and light sleep similar to the way that adults do.  

Now, the reason why I don't like calling it a regression is because the term regression implies that it's this temporary phase, that baby is going through and that all you have to do is just wait it out.  Your baby is not going back to being a newborn. Your baby's not going back to sleeping like a newborn. And they are now sleeping like an infant, which resembles that of an adult. So the solution at that age, if the baby relies very heavily on something like feeding or rocking to fall asleep, then we need to begin teaching that baby how to put themselves to sleep on their own without any help. By putting babies to bed drowsy but awake from day one you may be able to avoid being hit hard by this 'regression'.

It's definitely multi-faceted in that part of the solution needs to involve teaching that baby, how to sleep independently, right? Sleep, training, sleep, coaching, etc. There are many different approaches here. This doesn't just have to involve cry it out. If cry it out is outside your comfort zone, where you know you put the baby in the crib and you leave and you don't go back in- you don't have to do that. There are many other approaches that you can use, but part of the solution does need to involve teaching that baby to sleep so that they can connect their sleep cycles. 

At the same time, the sleep training is not going to work if that baby is overtired or under-tired. The daytime has to have proper structure that is biologically appropriate. We have to make sure that we've got those puzzle pieces in place first. And so that's why in my signature method that I use to help these moms get their little one sleeping, it's a four stage process for sleep training. A lot of parents don't even know that there is stage one or stage two.  These stage involves looking at the sleep environment, routines, schedule, the nap times the daytime, etc. That all has to be down pat first in order for stage three- the sleep training to work well. Check out my free masterclass for more information about these stages:

How to Get Your Little One CONSISTENTLY Sleeping 11-12 Hours at Night so You Can Be a Functioning Human!

Want to connect with Eva? Check out her website here! Or her Instagram here!

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: A former Tranquility by HeHe Team Member


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

Wednesday, September 8, 2021

Things that F*ck Up your Birth Plan


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 arti 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.

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


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).


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 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! 

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.

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