Eating pregnant.

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….)

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Always eat….

2- PROTEIN.

  • 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.

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then add…. 

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.

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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.

 Bagged apples or homegrown mini apples give you a blood sugar friendly serving. Large grocery store apples can pack way too much sugar for your body to handle all at once. Bagged apples also cost a lot less which makes it easier to afford to buy organic versions.  (These cute, lumpy little apples are from my yard.)

Bagged apples or homegrown mini apples give you a blood sugar friendly serving. Large grocery store apples can pack way too much sugar for your body to handle all at once. Bagged apples also cost a lot less which makes it easier to afford to buy organic versions.

(These cute, lumpy little apples are from my yard.)

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.

 Low carb breakfast treat: Chia pudding with coconut milk and fresh raspberries. I mix in a little liquid vanilla stevia to make it extra scrumptious. It’s a great replacement for sweetened yogurt, cereal and oatmeal.

Low carb breakfast treat: Chia pudding with coconut milk and fresh raspberries. I mix in a little liquid vanilla stevia to make it extra scrumptious. It’s a great replacement for sweetened yogurt, cereal and oatmeal.

for an added bonus….

5-FERMENTED foods. 

  • 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.

 Lovely fermented veggies made locally by my friend Evie. I made my own at home for years but now I just buy her wonderful goods. One jar will give you about 30 servings. Most grocery stores offer at least kimchee, sauerkraut or refrigerated pickles.

Lovely fermented veggies made locally by my friend Evie. I made my own at home for years but now I just buy her wonderful goods. One jar will give you about 30 servings. Most grocery stores offer at least kimchee, sauerkraut or refrigerated pickles.

THat’s IT! We are Keeping it simple. More to come in future posts!

Are you ready for more? For a super in depth, research based book on prenatal nutrition, check out my friend Lily Nichol’s two books Real Food for Pregnancy and Real Food for Gestational Diabetes.

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.

What midwives do all day.

 Midwife in Hinche, Haiti with her pile of charts on clipboards. The midwives loved when the volunteers would do their rounds so they could catch up on paperwork. We loved doing patient care all day and not having to chart at all.

Midwife in Hinche, Haiti with her pile of charts on clipboards. The midwives loved when the volunteers would do their rounds so they could catch up on paperwork. We loved doing patient care all day and not having to chart at all.

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:

 What this Alaskan midwife’s pile of clipboards looks like.

What this Alaskan midwife’s pile of clipboards looks like.

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.  

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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?

Is this Instagram post offensive?

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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.  
 University of Milwaukee, Wisconsin LGBT Resource Center.

University of Milwaukee, Wisconsin LGBT Resource Center.

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.

University of South Australia midwifery professor Mary Steen: “....it was a “wise decision” to retain woman-centred care.
“Midwife means with woman,” she said. “The woman is at the centre of a midwife’s scope of practice, which is based on the best available evidence to provide the best care and support to meet individual women’s health and wellbeing needs.”

 

Below is the article from the Daily Telegraph in Australia about the issue. Below is a screen shot of the original article.  

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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.

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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". 

Beyond the tub: Making your birth a victory.

 Photo by Home Grown Photography, Perth, AU  http://home-grownphotography.com/home/   

Photo by Home Grown Photography, Perth, AU

http://home-grownphotography.com/home/   

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. 

 

 

 

 

ACOG delivers good news for moms and babies.

 

We all could use a little good news, right?  After decades of skyrocketing c-section rates and increasing interventions upon interventions, this trend in US obstetrics is miraculously reversing.  The American College of Obstetrics and Gynocologists (ACOG) and other professional groups have put out some excellent recommendations over the past couple of years. Not coincidentally, they are recommending practices that we midwives have never left and have always done because, well, it's common sense and they work.

WIN #1: Hands off the low-risk mom

1) In January 2017, ACOG published a committee opinion piece recommending a "hands off" approach to managing low risk births. This is a victory for women and their partners who have been saying for decades they just want to be left in peace to give birth to their babies.

What does "hands off" mean to ACOG?

  • Artificial rupture of membranes a.k.a. "breaking of waters" is not necessary in normal progressing births
  • Active labor starts at 6cm instead of 4cm.  They cited studies showing lower rates of epidurals and need for pitocin. 
  • If your water breaks, it's best to wait for labor instead of automatically being checked in to the hospital and induced.
  • IVs should not be required or routine.
  • An end to forced pushing or "purple/Valsalva" pushing.
  • Using intermittent instead of continuous fetal monitoring. 
  • Allowing a "laboring down" or resting phase for 1-2 hours before pushing.
  • Allowing  position changes during labor and pushing as long as it doesn't interfere with monitoring.

 

WIN #2 : Encourage one-on-one & emotional support in labor

There was a time when US hospitals banned any labor support at all. Not even the father of the baby could be present. Women were held hostage and often treated very poorly with no support, witnesses or recourse. Only after nurses and mothers in the 1958 wrote an anonymous article in Ladies Home Journal about the "Cruelty in Maternity Wards" did people take notice.  

First, the Lamaze and Bradley revolution of the 70s-80s got the fathers in the labor room doing support. The 90's brought in the professional doula movement. A cascade of studies and data have proven the efficacy of continuous labor support. Doctors, nurses and hospitals are not always friendly to doulas despite their importance to women and their efficacy and insurance coverage for doulas is extremely rare. This landmark recommendation may change that.  

If a doula were a drug, it would be unethical not to use it.
— John Kennell, MD

Facts cited in the report:

  • doula care saves money for consumers and government
  • c-section rate is 40% lower in births with doula care
  • linked to shortened labor 
  • decrease need for pain medication 
  • families report higher satisfaction with their labor

WIN #3: Delay the cord clamping

In December 2016, ACOG took a good look at delayed cord clamping.  Thankfully, ACOG is now recommending ending the practice in healthy, vigorous infants. And yes, it can be done even in c-section deliveries.

While "delayed cord clamping" may be framed as a "new" practice that has health benefits, we might also consider prematurely clamping of cords is harmful. Immediate cord clamping is a harmful practice with no physiologic or medical benefit. Babies that have their cords clamped immediately lose a significant amount of stem cells, iron rich blood cells, immune factors and reduced overall blood volume with effects similar to suffering a hemorrhage. Three cheers for ending this antiquated, bad habit!

WIN #4:  It's okay to eat in labor. 

In 2015, the American Society of Anesthesiologists said it's okay to "let" women eat in labor. Since the beginning of hospital birthing, women have been banned from eating during labor citing the risk of aspiration in case a woman needed to be "put under" general anesthesia.  The result has been millions of women doing the hardest physical endurance task of their lives fueled only on ice chips. It took decades to amass the data showing that the harms of starving women overshadow the remote possibility that she may need general anesthesia. Finally, they have come around to say most women would benefit from a light meal during labor.  They have even found that in some cases, aspirating stomach juices is harmful if you haven't been eating because they are more acidic and caustic on your lung tissues. Ew. 

 YAY!!! No more sneaking food in the hospital!!!  Now you can eat your bananas and yogurt in peace, ladies!

YAY!!! No more sneaking food in the hospital!!!  Now you can eat your bananas and yogurt in peace, ladies!

In the real world, what does this mean? Am I going to automatically get a "hands off" birth?

Does this mean that my doctor won't touch the cord, will let me eat and I won't have to get induced if my water breaks?  Yes and no. Of all the various fields in the US medical system, obstetrics is known for being the slowest to change. 80% of US obstetric practices are not based on high level evidence. It takes an average of 11 years for practices to change after new evidence comes out. Sad, but true. 

Doulas of North America published this somber but realistic commentary on the new guidelines: 

Change occurs slowly in maternal medicine even with new guidelines or recommendations from a body like ACOG. While there are some encouraging suggestions in this Opinion, doulas are unlikely to see significant change to care practices or hospital policies as a result. The Opinion, does, however serve as a resource to educate our clients on the most recent position of ACOG including the research cited within it. Childbirth educators can also reference this document to encourage expectant families to ask questions and advocate for their preferences in regards to early labor management, comfort measures, monitoring, positioning and pushing.

— Adrianne Gordon, MBA, CD(DONA), Blog Manager

The good news is that if your hospital and doctor are not up with these recommendations, you now have good support to ask for what you want in labor. This is how change is made. It's how we got the dads into the labor room, how we got rid of the routine shaving and enemas as well as drastically reduced episiotomies in this country. Be assertive, be persistent, and bring robust labor support.

Or......you could just hire a midwife. 

 

Midwives have always encouraged women eat in labor.

Midwives have always left the cord alone. 

Midwives have always given one-on-one emotional support.

Midwives have always been "hands off" the low risk mother.

 

Hands off  and common sense practices are staple in the Midwives Model of Care. Midwives have been doing these things correctly for generations. You won't have to fight for the care you want. It's good news that more of the things that make midwifery care great will be available for hospital/MD patients. But it's even better news that you can get this kind of care right now from your local midwife!

 

*CAVEAT EMPTOR: Not all midwives practice the Midwives Model of Care or evidence based care. Most midwives that are employed and supervised by physicians and work in hospital are limited by hospital regulation and obliged to work under medical model protocols, not midwifery based protocols. Keep this in mind when hiring a provider. You will have the most flexibility if you hire an independent midwife with hospital privileges, or in a free standing birth center or at home. Also, remember, all of the these recommendations are for low risk women only!