How to become a midwife. Part I
This is the Spark Notes version of how I counsel my clients to eat. I have seen excellent results with those that follow this framework for eating. Right sized babies, lots of energy, less stretch marks and tearing, better moods, better blood pressure, less swelling. Food is not only is fuel (and comfort and pleasure), it is also an epigenetic signal to you body. What you eat instructs your body how to run, when to sleep and what to do. What you eat deeply matters in having a healthy pregnancy, baby and postpartum. Food matters!
It all starts with…..
1-Green leafy and brightly colored VEGGIES.
Try zucchini noodles, veggie frittatas & pizzas, lettuce wraps, grilled bell peppers & guacamole, celery sticks with hummus, sweet onions, baby tomatoes. Veggie soup, veggies juices and green drinks. Make fresh salsa and hearty greek salads. Make veggies your foundation for every meal. Think veggies first. (Confession… if I don’t plan for and prepare veggies first, I don’t eat them at all….)
Wild salmon and fish, cooked shellfish, organic chicken, grass fed beef & organ meat. If you can't afford organic, buy low fat cuts and trim/skim the fat when cooking and add fats like chicken breasts wrapped in bacon or baked in pesto sauce.
Pastured eggs are the perfect food for pregnant women. Eat two eggs a day minimum, pastured if possible. Per serving they are the cheapest source of high quality protein and buying the super high quality organic pastured eggs are quite affordable compared to other foods.
Good vegetarian sources of protein are sprouted grains, mushrooms, greek yogurt, nuts, spirulina, seeds, quinoa, whole potatoes with skins, sprouts, peas, lentils, wild rice, beans and of course....eggs!
Eat a small to moderate amount of protein with EVERY MEAL, especially breakfast. A bagel and cream cheese or a mochaccino is going set you up for spinning or crashing all day long.
3-Healthy FATS with every meal:
Avocados, grass fed butter, egg yolk, nut butter, drippings from grass fed meat, olives, coconut oil, seeds, nuts and cheese. Top your foods with dollops of whole fat yogurt, or dressings made with expeller pressed olive oil or avocado oil. Look for mayonnaise made from avocado oil and coconut oil. For an extra rich treat, use a little cultured cream (sour cream) or organic heavy whipping cream.
If you are only to buy one thing organic, make it your butter, cream and fatty meats. Toxins tend to build up in the fats of animals. Organic meats and fats are very nutritious loaded with ALA and Omega 3s. You dollar goes much further in paying a extra dollars for a pound of organic butter that will last 2 weeks rather than buying a few fruits that will only last a couple days.
eat a little, not a lot of…
4-Fresh or frozen FRUIT.
No more than 2 servings a day unless you are very active and have no blood sugar or weight gain issues. Buy in season and local if possible. Good non-organic options are watermelon, bananas, mangos, kiwis, oranges and grapefruit. Affordable organic fruits are bagged apples, bananas and my favorite, frozen berries. Avoid non-organic thin skinned fruit like grapes, strawberries and peaches to avoid pesticide exposure. Wash all fruits and veggies well before eating.
If you struggle with high blood sugar or want to limit weight gain, choose lower sugar fruits like blueberries, strawberries, crunchy pears, and green tipped bananas. Eat with a healthy fat or protein to make them satiating for a longer stretch and to avoid a blood sugar spike and fall.
Don’t fear, don’t eliminate, but be careful with….
4- Starches and CARBS.
Don't fear carbs. Just keep them unprocessed and small amounts. Everyone, not just gestational diabetics, are more sensitive to carbs and sugars during pregnancy. Throttle them down and you will feel…so…much…better!
Good portion sizes are: 1/2 cup of rice, a tennis ball sized potato or 1 single slice of bread. Enjoy sweet potatoes, potatoes with skins, winter squash, plantains, rice, wild rice, oatmeal without too much sugar, quinoa and seedy/nutty/dark bread and crackers.
Avoid refined carbohydrates like baked goods, pasta, breads, muffins, thick pizza crust. Enjoying an occasional cookie with your tea after a long walk with friends is fine. Eating a big scone or a muffin for breakfast every day? Not so much.
Replace super carby foods with healthy replacements like chia seeds for oatmeal, zoodles for noodles, cauliflower for potatoes.
for an added bonus….
Just a spoonful of probiotic foods with every meal will make a huge difference in your health. Probiotic supplements can be expensive, many have limited shelf life, lack “prebiotics” and can be questionable in efficacy. Fermented foods on the other hand, have been used for thousands of years to improve health.
There are a lot to choose from. Kefir, kombucha, fresh sauerkraut, kim chee, kombucha, pickles and other fresh fermented veggies. Try Bubbies pickles...they are available nationwide. Or even better- find a local producer at your local farmer's market.
Commercial yogurt doesn’t have a lot of probiotics in them since they are pasteurized so don’t rely on them to get the bugs you need. Homemade yogurt is easy to make, packs a probiotic punch and saves you money, too. Consider using your milk allotment from WIC to make big tubs of fresh yogurt. Also try kefir, a fermented milk drink which has more variety and quantity of probiotics than yogurt. You can buy kefir in most grocery stores and it’s also pretty easy to make, too.
THat’s IT! We are Keeping it simple. More to come in future posts!
Prenatal and even preconception nutrition is the foundation of a vibrant, successful pregnancy, birth and postpartum. Take it seriously. It will make a world of difference for you and your family.
People say how lucky I am to “catch babies” all the time and be around newborns. They are in awe that I could be a births and experience the joy of new life “all the time”. However, they are sorely wrong when they imagine that I get to work with women and babies “all the time”. Working as a midwife more often than not looks like this:
4 out of 5 tasks in any given day are not related to patient care. It’s not just midwives feeling this paperwork burden. I’m sure you have heard about physicians, PAs and nurses under the same pressure. Like this article in Forbes reporting on a study that found doctors spend ⅔ of their time on paperwork. And, they report it’s getting worse every year. 4/5s of my time or 2/3rds? It depends on the day. But I count on every visit generating an equal amount of time on writing letters to employers, calling the lab, letters back and forth to insurance, ad nauseum.
Peeps are sorely wrong when they imagine I get to spend all my time helping pregnant women, catching babies, counseling breastfeeding and cuddling newborns all day.
Even my daughter….
(…thinks that’s what I do when I leave the house)
Just like doctors and midwives, nurses spend more time doing paperwork than doing patient care. This is one of the major reasons I think people need to hire a doula or bring experienced support into the hospital with them. No matter how awesome your nurses are, they could lose their jobs by leaving their keyboards too long in order to physically support you.
I don’t want to complain too much. I am grateful for many things.
I am grateful to have access to insurance billing and medicaid reimbursement for low income families.
I am grateful that we have access to technical training, accountability for all the midwives in the state, statistics and a support network.
I am grateful We can do heart defect screens, metabolic testing, have access to lab & diagnostics, have easy access to physician consults…
But with all of this modern medical access comes modern medical paperwork!!!
What can we midwives do? Often I consider switching back to a cash practice. Yet, I don’t believe I would be able to serve very many families that way. We all sacrifice big time to pay into the health insurance machine. We want to “use” their insurance. Or I could work as an unlicensed midwife in a state or country that allows it. 90% of my paperwork is insurance and state mandated charting and reporting. I have to report or communicate with at least 4 state offices every time I have a birth. Sometimes more.
What are the solutions?
I have been moving back to a paper charting in the room which is a huge leap against the current trends to electronify everything. Electronic charting was supposed to save time but did the opposite. This Business Insider article sums it up well:
..the more our country spends on traditional EHR software, the more time providers must spend on them, the more dissatisfied they become, the more frustrated patients feel, and the more expensive health care gets.
Any suggestions?! Someone out there have any idea how we can ease this burden so that I can see more mothers and babies and spend less time on the paper?
What could possibly be offensive about this Instagram post?
No nudity. No f-bombs. No pools of blood or up close vag shot. I'll tell you why. It's the word "WOMAN" on the shirt. It celebrates the power of woman. Specifically, the power of women to give birth.
It what social justice warriors call "non-inclusive" language and a form of hate speech
To support women, to serve women and to hear that mighty woman's "roar" is not okay. Suddenly the being a feminist is not left/liberal enough. In fact, the feminists are the new enemies. The LGBTQ has a name for those of us who are into empowering women. It's a slur. In case you didn't know...you are now a "TERF", which stands for TRANS EXCLUSIVE RADICAL FEMINIST. When we tout the power of "woman", we are excluding men who give birth. And asexuals that give birth....all the transgenders, bigenders and all others who don't identify with women but still grow a baby in a uterus and push it out of a vagina. In general we are talking about the biological female who chose to change into a man or other, then chose to use their female biology to have a baby.
For them, the tiny, tiny population of folks are mad that we use the words birthing women, mother and the pronoun "she". They feel hurt, and unsafe. And the Social Justice Warriors are on the warpath to make it "right".
These are the guidelines we as midwives are now supposed to use when referring to our pregnant and birthing population in speech and in writing:
- You can't say birthing or pregnant woman, you have to say pregnant PERSON
- You can't say, laboring woman. It has to be laboring PERSON.
- You can't say mother. You have to say PARENT.
- Maternity Care and Maternal Child Health is also on the chopping block. A suggested alternative is Parental Child Health and Parental Care (??) Again, misleading and confusing and not medically correct or acceptable for publication.
- Any "Women and Children's Hospital" would have to be renamed.
- Then there are the pronouns. You cannot use "She or Her" when writing or speaking about your clientelle, unless speaking directly about a self describing "she/her" client. "THEY is generally the non-binary pronoun of choice that we are supposed to use. However, according to the TSER, The Trans Student Educational Resources, "There are an infinite number of pronouns as new ones emerge in our language." Below is a list of pronouns that are emerging as politically correct alternatives to replace SHE/HER/HERSELF. Instead we may be required to talk as if everyone is plural with the THEY/THEM/THEIR, as if you are speaking to conjoined twins or someone with multiple personality disorder.
So why do you care? Why not just keep using she/he and let them do their own thing and not worry about who will be offended?
1-As midwives, we are sensitive folks and want to take care to nurture and make all of our clients feel comfortable.
2-Because it soon may be illegal to use traditional pronouns and gendered speech. I am not kidding. In Canada a bill was passed where using the non-inclusive pronouns is considered hate speech and thus a hate crime.
Supporters of the bill say that that is not the intention of the law to make using the word "birthing woman" illegal. However, we know that laws have unintended consequences. No one intended the Affordable Health Care Act to drive up insurance premiums to $1500 a month with a $5000 deductibles. But that is exactly what is has done in Alaska. It wasn't the intent. But it was the direct result of the law.
3-On a national and international level, there is a push to change our entire educational and certification processes to gender neutral. Already in the US with Midwives Alliance of North America changed it's Core Competencies to remove any reference to "woman". That is just the start. At the MANA national conference which I attended a few weeks ago, the leadership was clear that the most pressing issue and goals of the organization are diversity and inclusiveness, not the promotion of midwifery.
This cultural shift is not just happening in the US. The Australian College of Midwives wisely pushed back against a bill that would require them to use gender neutral language exclusively. I wish our US midwifery association would follow suit. Instead they are full steam supporting the elimination of all words feminine, foolishly pandering to the well funded LGBTQ lobby, whose representatives were very conspicuously present at our conference.
Below is the article from the Daily Telegraph in Australia about the issue. Below is a screen shot of the original article.
And here below is the revised title that popped up a day later. Interesting, isn't it? The edited title makes the midwives seem like they are being unreasonable as they "rail" against a "code of conduct". No doubt the language police were behind this. Apparently is par for the course in the Social Justice war zone. I am new to this arena, just having been sucked in the last few weeks. I have much to learn but I have seen bullying and intimidation first hand.
Where is this all leading? what does this all mean?
I really have no idea. I am not a political person. I have been totally out of touch with the whole Social Justice scene and just minding my own business serving families on the edge of survival in the Gulf of Alaska. People bust ass for 12-18 hours at a time to make a living and don't have the luxury of feelings hurt by semantics. But now that I am being asked to rewrite my 98 pages of practice protocols and informed consent to remove any reference to women, I am pissed. Now when I speak in public or teach midwifery classes I have to tip toe around pronouns and walk on eggshells. Now, SJWs, you have my attention.
Bottom line, this is what I believe: I should be allowed to refer to a clientelle that carries a baby in a uterus and pushes a baby out of a vagina as a she, a woman and a mother. Don't ask me to remove the ancient divine feminine from birth. Don't ask me to ignore the archetype of mother, the mother that brought each and every one of you into existence. Don't ask me to remove the word "woman" from a profession that means, literally "with woman".
Look at this mom is glowing with a sense of power and accomplishment. It's the goal for all of my clients. Healthy mom and baby of course, but that face. Mom is on fire.
It doesn't matter where she gives birth. This isn't a "home birth"or birth tub thing. I have seen women defeated and traumatized after a water birth. I've seen them empowered after an unplanned cesarean. The birthing tub is not a magic cauldron that transforms you into a birth diva. The spa like atmosphere cannot change what is going on inside of your heart, body and mind or change the attitude of the people around you.
The reasons I believe that I see so many empowered, happy births is not because of location. Sure, sometimes the home looks like a Pinterest scene, with dim lights and essential oils wafting in the air. But, it's irrelevant. I once set up for a home birth with a very healthy/artsy/crunch mom in a "Waldorf" inspired home. The walls glowed with watercolor paint, she burned beeswax candles hand made by her older children. After many hours of labor, the mom ended up transferring to the hospital and was visibly much happier and comfortable once she arrived. She had a lovely birth and was glowing afterwards. The doctor offered to let her go home a few hours but she declined. Even though she was hungry and there was no food available other than jello and pudding until the kitchen opened in the morning, she would rather starve than go home. She would be trying to sleep on a thin mattress with beeping machines and buzzy fluorescent lights. Her husband would have to go home and tend to the older children. But despite these discomforts, a night in the hospital was just what she wanted, and just what she needed. A break from the kids, a time to snuggle alone with her newbie uninterrupted. It was just perfect.
What matters in childbirth is not the tub or quaint environment. What matters is optimal health and wellness for mama and baby, heart...mind...body. What matters is respect and support by providers and that your needs are met. Many beautifully decorated birthing centers have high transport and risk-out rates. Up to 50% of women who start there end up birthing in the hospital anyway. Data shows us that beautiful hospital rooms do not correlate with beautiful birth experiences. Some hospitals use Bait and switch techniques as marketing campaigns for their "homelike" expensively decorated birthing wings, include one I know of that offers a steak dinner for the parents after the birth. But luxury hospital suites are rarely funded by low revenue vaginal births. They need cesareans, epidurals and NICU stays to be profitable. Low intervention, uncomplicated births are not profitable. You cannot bill insurance for extra hours of "hands on" support but you can bill a lot for medication! Sometimes the most humble hospitals have the best outcomes and satisfaction rates. So don't be fooled by fancy decor.
When I see a mother take labor head on, dive through her fears and discomfort to achieve her goals, it is the most thrilling and goose bump provoking moment, no matter what the location. It's especially true when a woman has had a disappointing or traumatic previous birth when she defeats the ghosts and doubts of the past. The exhilaration of a gold medal victory for the common woman is what makes doing birth work amazing. I believe that any woman, in hospital, birth center or at home can make her birth a victory.