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! 

The Beginning of Home Birth with Kaitlyn Fusco

Wednesday, March 17, 2021

The Beginning of Home Birth with Kaitlyn Fusco


Today, we are chatting with Katelyn Fusco, Host of Happy Home Birth Podcast. We are covering home birth and how birth has transformed over the years. Katelyn is sharing who is right for home birth and the top home birth myths. We are also diving into stickier topics like the business side of birth and how legislation can impact women’s health. We shine a spotlight on consent and continuity of care as well. I'll hand it over now for Katelyn's thoughts!

We are so ingrained now, especially in the United States, to think that birth is a medical event that just has to take place in the hospital. I mean, that's just in our minds. I know growing up, that's how it was for me. My mom had all three of her children as C-sections. So when I was growing up, I thought, 'Okay, well, I'll have C-sections for my babies. Birth is surgery the end'. I don't think I'm alone in that whether, you know, you were born from a cesarean section or however you got here, it's very likely that you grew up thinking that birth was a medical event. It's kind of crazy because we haven't even had hospitals for that long. So the fact that birth has transitioned from something that was just a it's kind of like the extraordinary normal, you know, like birth is extraordinary, but it is normal. It's transitioned from that to something that we have to have like flashing lights and warning signs.

Let's go ahead and start back. I mean, biblically look in Genesis, midwives are mentioned in Genesis. Like this is from the very beginning we have been giving birth and women have been supporting other women in birth. So this is not new. Midwifery is not some new age woo-woo thing. This is literally from the beginning. So I love to start there. I also like to talk about the fact that when in the past we were giving birth, it was not so isolated. So now, even if you have a doula, even if you have your partner with you, you are going into a hospital typically where you're giving birth. And it is a teeny, teeny, tiny little group, maybe, maybe a threesome. You, your partner, your doula- it's a small group that we're giving birth with. Back before the hospital and before this became the norm birth was a community event. We were growing up seeing women give birth hundreds of times before we gave birth. Seeing, 'Oh, wow, this, this works. Of course, this is what we do'. Moms, sisters, aunts- were at the birth together- we were all there and we were all supporting the person giving birth. So birth wasn't this crazy shocking thing and we knew our bodies were made to do this. We knew that we were created, we were designed to be able to give birth.

That doesn't mean that every single time it goes perfectly, of course birth is wild. It is a wild event, but it is something that is not supposed to be just deeply in our bones that we're fearful of. I think that that is the biggest issue is there's just become this shift, especially in the United States. If you compare our maternity system to other places, you know, it is so different. Home birth is, is highly more common in other countries. The way that The American Medical Association formed, it was a business. One of the things that they did was instead of working with midwives, it was, 'These people are not educated. We are educated'. So they realized that they could trash these midwives who had decades and centuries of knowledge passed down one to the other one to the other, you know, these amazing established communities. There were smear campaigns and they talk about this in the 'Business of Being Born', which is a great documentary. I actually spoke to a midwife, my friend Janell, about this and about how there were actually transcripts in Varney's midwifery book from the AMA where they were talking about how they were going to convince the public, that midwives were not quality even though they knew and acknowledged that their outcomes were worse than those of midwife attended births.

How did we get from a primarily home birth to hospital?

It started off where doctors had become prevalent as a career, but birth was left untouched there for a minute because that was, that was woman's work. Then they realized, 'Wait, hold on a second- we could make money out of this'. So that is what happened. It did start at home. Doctors did begin attending births at home, but the shift to the hospital was massive. It revolutionized everything, because it turned into, 'Why would you have your baby in your home? It's dirty, it's unclean. It's unsterile.' It began like, 'Oh, I'm going to be fancy. I'm going to go to the hospital to have my baby.' Then it filtered down throughout society and became the norm. like, Oh, well, you go to the hospital.

It was not like the hospital today, like women were going into the hospital, but their partners were not with them. They were going into these back rooms. We don't know what happened. The partner has no idea what's going on. They would use like sheepskin wraps around their arms so that when they were held down with all of these drugs, they wouldn't leave marks. The drugs that they were giving them actually didn't help with pain management at all. It was knocking them out. They're basically in and out of consciousness this entire time. Do you think it's easy to have a baby that way? It is not my friend. It's just disturbing to think how behind the times they were with their practices, as opposed to what was going on in the community beforehand, when using midwives, you know? The hospital was seen as the safe option, but in reality, if you looked at what was going on it was the last place you would want to be.

Understanding Your Home Birth Options

So many people have no idea that home birth is an option. Hw can you have informed consent when you don't know all of the options? When it comes to home birth, it's not talked about a lot. 1% of the population gives birth at home right now in the United States. 1% that's, that's teeny. But my thought, and the reason that I created the Happy Home Birth Podcast is it would be a lot higher if people knew that it was an option and that it was safe.

That's where we need to be going. No home birth is not for everybody. Home birth is for low risk mothers. The majority of people do fall into that category over 90%. So 90% of people would be safe to have a home birth. That doesn't mean that they would be comfortable. That doesn't mean that I'm saying, well, you, if you're low risk, you just should, but that the safety factor is there. The great news is that midwives, you know, if, if you're choosing to use a midwife, they are trained in low-risk birth. There they are so competent at assessing what is and is not low risk. If you ever crossed that threshold of safety they will go ahead and transfer your care over. This would be the appropriate time to transfer care.

Also, it's important to note that though, there are different types of midwives and they do practice in different ways. Typically there is an overseeing type of provider that will also be able to check off and say like, 'Yes, you are low risk. You are qualified for a home birth.'

But your house is so...germy.

As the research with the micro-biome has just taken off in the last few years. We are realizing that theory of all germs being bad and scary and dangerous, it's just not accurate. The other neat thing that's going on with the micro-biome is that we're learning a lot of people have always assumed the placenta, the amniotic sac is sterile, but it is not. We are finding there is bacteria already there. So when the baby's not in this sterile vacuum, they're already being exposed to your microbes, to the microorganisms inside of your body. So they are already attuned to the environment. So it's kind of cool to think about the fact that, 'Okay, we are giving birth in the place that we created the baby- the place that we have grown and nurtured this life- we're giving birth to that new life in this atmosphere.' Is that not actually the safest place t be? We're not exposing them to something new, we're exposing them to the friendly things that they've already grown accustomed to.

Let's talk about the business of being born. What do pregnant people need to know to be informed?

The first thing I think is the most surface and the easiest for us to wrap our minds around. So 99% of people are giving birth in the hospital? A large percentage. It's busy, OBGYNs are busy. So the first issue is that the way that this system has been created. You go in for your prenatal care and the majority of your appointment is not with your doctor. The majority of your appointment is sitting in the waiting room. Is there a lot of education going on between you and your provider? Not often.

The other question is, is how often are you seeing the same person? How often are we having continuity of care? We don't know who the heck is going to show up when we're having our baby. So there's overcrowding of practices. There are so many patients coming in. There are so many doctors to take care of all of those patients. And of course they want to grow a business. They want to be able to add more doctors to generate more money. So these practices are getting larger, larger, larger.

There's no time for connection. It's not even that it's this evil situation or intentionally evil. It's that it's just a busy place. So we're going to get in, we're going to do what we got to do and we're going to get out.

The second issue that we could discuss is the fact that these obstetricians are well-versed in surgery, right? That's what they went to school for. However, do we need to be looking for pathology in every single birth? No, we don't because like I said, 90% of us are low risk. And then of those 10%, how many actually need a c-section? It's a very small percentage of the 10%. Which is not what we're seeing across the country.

We're putting these people who are trained to see pathology and who are trained in surgery in a situation where they're not really needed. It doesn't make sense that their job is to care for all pregnancies. And, if you look at other places, that's not how they divvy up the responsibilities. Midwives are taking care of the majority of low risk clients.

We've got another situation to consider: How are we looking at birth? Are we looking at it as a normal event? Or are we looking at it as a pathology?

When it comes to laws, most doctors, have a three year period where somebody could sue them. When it comes to OBGYNs it's 21 years. because they can look back and say, 'Oh, well, they're having this issue that's related back to birth.' So obstetricians are legally in a tough place. They can get in a lot of trouble. And so it's a lot of money to cover them insurance wise. They really want to prove that they did every single thing that they could do to get that baby out safely. So if there is even the slightest of like, 'Oh, well the heart rate went down for just a dip- take her to surgery.' Let's do, do, do to prove that we did everything, everything that we could to make sure that this baby came out safely the end. What that leads to, is it way more intervention than is actually necessary.

We add these three pieces up and it's kind of scary if we're not super confident in our care provider. If we don't feel that we are completely aligned with them and that they totally understand where we are and see our pregnancy as an individual and unique pregnancy.

I think that it's so easy for us to say, 'Oh yeah, OBs are the worst. Doctors are just awful.' And that's of course that's not true. It's just like any other profession, we've got great ones. We've got ones that are in it for the right reasons. And then we've got trash. Some humans just don't care as much. That's the reality. It's important for us to remember that. These people, these people are people and they are doing their best even if it is misguided.

The other issue that I didn't touch on is the fact that the information that they are working on is outdated. It takes so long for information to be trickled down to practice. So ACOG might come out with a statement about episiotomies. It'll take 25 years for a episiotomies to not be done. It takes that long for things to go down into practice. These doctors are so busy. They went to medical school 25 years ago. They learned the stuff in medical school. And now they're in the trenches. Their head is down. They're working on these massive patient loads. They're in the hospital, they're in their clinic. It's busy. Do they have time to sit down and read like the evidence based birth website all the time? No. So we are there, they're practicing on with, with standards that are just outdated.

That's one of the most frustrating parts to me. If you are going to be dealing with people's lives and the lives of their babies, you just have to care, there's no other way around it. You're going to have to find the time you said you would. You promised. You took an oath to take care of people- to give them the best care. And that's truly how I feel. I hold myself, my doulas and, my team to that same standard. We're not medical professionals. And I get that. They are 1000% busier than we are, but you promised as an OB to take care of people and you've got to do that. It's one of the priorities.

We are consumers of this broken system. We have to start saying, 'Listen, I'm not going to accept this.' That's a lot easier said than done, but I will give a great recommendation- 'Shared Decision Making: Bring Birth Back Into The Hands Of Mothers' by Dr. Brad Bootstaylor. He talks about the fact that you've got to hold your care provider accountable. To be upfront about the the things that you are looking for in your care provider. So you can see if you are an ideal fit. Now, the important thing for us to remember is, like I said, a lot of these practices have how many providers? We need to make sure that all of these providers are fitting. If they're not, then we're saying, 'Okay, I'm going to go look for someone else who closely aligns with me.'

A lot of times I think that we just go with what's easiest. We need to be very serious about this. This is the birth of our child and this is our birth into motherhood. This is a day that will be remembered forever. So we need to have the right people supporting us. We need to be asking them questions on all of the things that are important to us and make sure we're getting the straight answers.

And then of course, from, from my perspective, we need to be considering other care providers. We need to be considering care providers who are trained in physiological childbirth like midwives. They're trained in the fact that birth is an, a beautiful ordinary, extraordinary event.

So really considering if a midwife is an option for you. When you go to see your OB, how often, like how long do you talk to your OB? When you go to see a midwife, I'm just letting you know, your appointments are usually 30 minutes to an hour and only a brief period of that time. It is so holistically focused on you and the baby and all of this hands on care and attention during the prenatal period so that they can be hands off during the birth. The more positive birthing experiences that we have and that we share with others and tell them of their experiences, the more people are going to feel empowered to do the exact same thing. And that's how a revolution has started.

How do you know if you're right for home birth and then also, how do you go about finding a midwife?

We do know that 90% of moms are low risk. So if you do not have anything that's labeled high risk, you are more than likely a great candidate for home birth. As for hiring a midwife, I would recommend going to https://mana.org/.You can get a breakdown of your state and what the regulations are, what is, and is not considered legal from a care provider standpoint. Then you can start to search for your midwife.

BOOKS MENTIONED:

Dr. Brad Bootstaylor —book: Shared Decision Making


PODCAST MENTIONED:


Ep 59: "But What if Something Goes Wrong?"- How Midwives Handle Emergencies at Hom‪e‬




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