VBAC After One, Two or More Cesareans

What is a VBAC?

A VBAC is a vaginal birth after cesarean.

If a woman has had a cesarean and wants to plan a vaginal birth for her next, it would be considered a VBAC, and the number after it depends on how many prior cesareans there were.

What are the chances of having a successful VBAC and who is a good candidate for a VBAC?

The stats range that 60-80% of women, who have had previous cesareans, are candidates for a successful VBAC. In actuality, most healthy pregnant women carrying healthy babies are candidates.

The chances of a successful VBAC are higher if a woman is using a midwife, even higher in free standing birthing centers and home settings.

Going to a hospital and working with an OB/GYN with high cesarean rates, will increase the likelihood that a woman will have another cesarean.

In some hospitals, there are a lot of restrictive procedures, like continuous electronic fetal monitoring, confining a laboring woman to lay in bed, not allowing her to eat or drink, routine IVs and time limits, which increase the risk of a cesarean.

There are many benefits to a VBAC, that are physical, emotional, mental, and spiritual.

These are only a few important benefits on the long list:

• No risks from major abdominal surgery. This is huge.  Unfortunately, a cesarean can lead to trauma to the internal organs or reproductive tract, risk of hemorrhage, complications with scar tissue, long term post operative pain, wound infection, blood clots, stroke, and possible respiratory problems for the baby. High rates of cesarean section contribute to high rates of morbidity and mortality – and this is occurring in modern countries such as the US, which ranks among the bottom of them in terms of outcome stats.

• Easier postpartum healing and recovery.

• Baby receives needed bacteria for optimal health, from mother when passing through the vaginal birth canal.

• Breastfeeding may be more successful

• No potential harm to future fertility.

• Feeling more positive about the birth experience

• Increased sense of empowerment.

• More involvement of family and support people.

• Less risk of postpartum depression and emotional birth trauma.

What is the main risk of a VBAC?

The risk of separation of the one prior uterine scar is approximately 2 in 1000 VBACs, but often it is a mild superficial dehiscence (slight separation of some layers of the surgical wound) that has no clinical significance and does not impact the health of mom or baby. The risk of severe life-threatening emergency from a partial or complete uterine rupture of all the scar layers is significantly lower – a highly unlikely occurrence, significantly less than 1 %., 1.36% after 2 cesareans, slightly higher after three cesareans, with a higher comparative maternal and newborn morbidity with each repeat cesarean - but still in perspective, low, and depends on a variety of factors related to your individual situation. The main risk is of a VBAC is this rare catastrophic rupture of the previous uterine incision. This rare total disruption of the uterine scar risks both the mother and her baby, and can lead to catastrophic outcomes. It cannot be ignored and must be monitored for appropriately; but it cannot be exaggerated or make the risk of repeat cesarean less alarming. Frank uterine rupture is often mistaken for more common mild separation of the previous uterine scar without consequence, happens in less than 1% of all pregnancies. Even ACOG released guidelines that it’s reasonable to consider women with two previous low transverse uterine incisions to be candidates for trial of labor and to counsel on the combination of other factors that affect their probability of achieving successful VBAC.

But, it is getting harder to find a provider to attend to your desired vaginal birth after one cesarean let alone after two or more. It is still possible, and you have the right to decline another cesarean, but it is ideal for you to find a provider and setting most supportive to birth YOUR way safely.

Although every decision has risks, a VBAC is a reasonable, appropriate and safe option. If a woman panning a VBAC decides to give birth at home, I highly recommend working with a well trained and experienced midwife and consider the distance to a hospital (30 minutes or less driving time is ideal).

There are risks and benefits to every kind of birth and in every setting. I provide women with evidence based information, encourage each family to dig deep and look at the pros and cons to having a VBAC in a hospital setting, free standing birthing center or home, vs a routine cesarean and have informed consent for her birth.

Are there benefits to a cesarean?

A planned cesarean is in a controlled environment, and some women find great comfort in that knowing. Perhaps a woman has had a previous traumatic, long labor the first time and they just don’t want to go through that experience again. Some women are very anxious about that and they just feel safer knowing they will have another cesarean.

I take that seriously, because she won’t labor well if she doesn’t feel safe.

Like I mentioned before, the serious risks for a VBAC can be often prevented, treated or transferred to surgical care in time, with a skilled midwife or obstetrician who is attending to the laboring women, aware and mindful of the symptoms that lead up to that.

Thankfully some hospitals are now at least allowing more time for baby to get the cord blood from the placenta, skin to skin bonding, and her partner or main support person in the operating room. Some hospitals and providers are performing “gentle cesareans” – cesareans that are family and woman centered, and try to provide the environment of a natural birth as much as possible. This is a wonderful attempt to restore humanity to birthing in the operating room

In most cases, a VBAC is a safe option.

I share the opinion of many concerned with improving maternity care and reducing our rising rates of maternal and newborn death and serious health consequences from the interventions in childbirth, that a woman should not be forced to have a major surgery against her will, rather provided research and empowered to make her own decision, considering she is having a healthy AAOG removed the previous unreasonable restriction requiring immediate availability of a surgical staff for an emergency cesarean, as most hospitals around the country, let alone free standing birth centers and home settings, do not meet this criteria. Most hospitals are not able to have a surgical staff at all times and cannot perform an emergency cesarean in under 30 minutes.

Despite this, research is showing that far too many obstetricians and the midwives they back do not offer VBACs after one cesarean, let alone more. They routinely recommend repeat cesareans because they may fear law suits, succumb to scheduling pressures, have restrictive hospital or malpractice insurance policies, and/or feel pressured to uphold certain standards among their colleagues who are not supportive of VBAC. The hands of a midwife whose collaborative obstetrician and hospital do not support VBAC can often be unnecessarily tied as well for these reasons. Most repeat cesareans are not actually medically necessary, and are commonly recommended due to various non-medical reasons. This is very concerning.

What also concerns me is that the risks of a VBAC are magnified in conversation with women, while the risks of a repeat cesarean are downplayed, so women may feel forced, afraid and powerless.

I want women to feel like they have a voice, as they do have a legal and medically ethical right to autonomy over their bodies, their births and their baby’s.

Some women who want to VBAC have limited options and local doctors in the area are only offering cesareans. Some feel they have no option other than having an unattended homebirth, or labor alone at home until the last minute without any monitoring, or not be truthful with their providers about their previous cesarean birth – all of which can increase the risks for her and her baby.

A trained and experienced midwife who is continuously with the woman in active labor, can detect concerning signs and symptoms before they can become a crisis, and she be transferred and treated in time to save her and her baby’s life and heath.  A midwife wears many hats, one of which is protecting the space so the natural process of birth can proceed with ease and grace, and another is a lifeguard – to know when and how to intervene to prevent problems or manage emergencies.  There are many wonderful obstetricians supportive of VBAC who have this training and style of practice as well; they are just harder to find.You have the right to decline the repeat cesarean, and find a more supportive skilled provider at home. There are midwives and OBs who do it and post about it around the globe. It is worth every penny to even travel quite a distance to a practice who honors your choices. You REALLY have to want it, and you must prepare as best you can to set yourself up to succeed, like it’s your Mount Everest to climb, to have your healing, redemptive beautiful healthy birth.

Last tips:

If a woman knows she wants to have another baby, I would start with research and education. Ask yourself: “What do I want and why?”

A woman should get the support she needs. Most women who have had one or more prior cesarean births have issues they need to discuss and heal from.  One of my dedications and areas of expertise is creating space so a mom can debrief, process and recover from her previous upsetting or traumatic birth experience, as well as plan for a better one next time around. Schedule a coaching call with me for more personal guidance if you need.

I tell mamas to do what they can to educate, prepare and empower themselves in a whole different way than last time as I want them to succeed, build their circle of support, and include in their birth team advocates to speak for them when they are in the heat of labor. I tell them to prepare for a natural vaginal birth. The mind, body, heart and spirit can prepare for a natural vaginal birth - and a deeply positive, beautiful and empowering one. Yes, it takes work and practice, but it is worth every penny, every effort and amount of time you put in, if this is the birth experience you want and dream about. This is one of my passions and main focus of my online childbirth prep course Anne’s Guide to Pregnancy, Birth and Postpartum - sold separately or bundled together in adjunct to my Natural Birth Secrets books 2nd edition and Trauma Release Formula 2nd edition if you need help previous healing birth trauma - both extensive but very different resources that compliment each other to heal and prepare for your different next birth.

I also recommend hiring an awesome doula, as those who have a doula are less likely to have a cesarean.

A doula is amazing because they offer the mothering comfort and support that our ancestors had.  When women would give birth in their tribe or village, and they were surrounded by mothers, aunts, sisters, grandmothers, and the other women of their community, they received that mothering support by women who were comfortable with birth and relaxed around it. Fear has no place in birth, and a doula provides needed calm and loving support.

Remember, In the end it’s not in our control, and we let go and surrender,

If you do all of these things and end up having a cesarean, it’s not a failure. There is no failure in birth. It is a birth, a belly birth, and it’s the birth of your baby and you as a mother. It is the birth of your family and your partner as a parent. Stay present, stay involved and keep a positive mindset. Focus on the blessing, that you did all that you could, and thankful for modern medicine, which saved you and your baby’s life and preserved health. Also, you can ask for a gentle cesarean, which restores humanity to the operating room by doing such things as allowing your support people in with you, enabling baby to emerge from the incision simulating as much as possible a vaginal birth to help baby clear his/her own lungs, enabling you to participate by lowering the drapes so you can see your birth, giving you sterile gloves to receive your baby, optimal umbilical cord clamping so baby can benefit from the cord blood, encouraging immediate skin to skin bonding and early breastfeeding.  

Healing can occur afterwards, and may take time and lots of support. But there is no place for shame and negative self judgement here.

PMS Premenstral Syndrome; A Natural Alternative Part 2

Natural Treatment for PMS

Many PMS symptoms do respond well to simple lifestyle changes and safer, more affordable,  traditional time-honored remedies. Experiment with the suggestions below and find those that work best for you. Allow a few cycles with each to properly assess their impact. But, full recovery  begins when you start by honoring your cyclic lunar nature and giving yourself permission to take a monthly hiatus. Trust your body’s inner wisdom and ability to tell you what’s needed. Use this information to reset and heal, embrace your inner wild and the full range of emotions you feel from grief and rage to joy and calm. 

The goals are to reset your body and its natural ability to heal and function optimally by: 

• Reducing root causes like inflammation, toxic exposures, estrogen excess and stresses, gut flora and blood sugar imbalance

• Getting adequate nutrients from food, nature and supplements

• Supporting your stress response, liver and regular bowel movements for detoxing

• Empowering mindset and nurturing your spirit.

SELF-AWARENESS

To increase self awareness, start a journal of your symptoms, noting when they occur in relation to your menstrual cycle, the degree to which each one bothers you or interferes with your ability to function as usual, what triggers them, and what helps. Also pay attention to the food you eat and how it affects you. Try to list at least one possible symptom and some ways in which the PMS experience can be viewed and used to your benefit, an opportunity for deeper meaning and transformation.

Identify vulnerable times and plan accordingly. For example, avoid situations likely to provoke difficulties, put off important decisions and problem solving until later in your cycle when you feel more balanced and clear, schedule extra time for rest, relaxation, enjoyable activities, and support from family and friends.

Openly acknowledge your symptoms to yourself and others most affected to enhance understanding and acceptance. Create your sisterhood tribe of like-minded uplifting women and share your experience with them. We are wired for community. Aside from feeling that you are not alone and isolated, community helps you feel connected, understood and validated, as well as loved and supported. This may also lead to a good laugh and soul nurturing hugs…both are very healing. If you don’t have a community, start by finding a local red tent meetup near you, join the red tent movement or organize your own red tent or moon lodge women’s circle.

DIET AND LIFESTYLE

A healthy diet can make a world of a difference and has short term and long term health benefits that extend far beyond relief of PMS. Maintain excellent nutrition by eating 3 whole, real, organic meals and healthy snacks throughout the day of a variety of nourishing foods. Listen to your body and eat only when you are hungry. 

Include lots of organic fresh fruits, vegetables, nuts and seeds, and fermented foods like kimchi. If you eat grains, make sure they are whole. Eat 20-30 grams protein three times daily such as in nuts, nut butters, seeds, beans, and pastured organic animal protein if not vegan (like wild Alaskan or Norwegian salmon and other fresh cold water fish from non polluted waters, organic pastured eggs, chicken, turkey, beef, lamb, and organic pastured raw goat or sheep dairy). Add a few TBS of ground flax seed to your daily smoothie, applesauce or oatmeal.

Make sure to boost your intake of cruciferous veggies like broccoli, cauliflower and cabbage to balance your hormones. Load up on healthy fats and protein if your symptoms are primarily emotional. Many women feel best physically and emotionally by avoiding genetically modified foods, cane sugar (raw honey, maple syrup, coconut and date sugar are better substitutes), soy, dairy (especially cow) and gluten (choose gluten free grains like oats, kasha, millet, quinoa, and nut flours for baking), and organic living. Eat a paleo, or ancestral diet, basically basically how we used to eat when hunting and gathering, before the mass industrialization of food. Switch to using organic foods, body and household cleaning products without harmful toxic chemicals as much as possible. 

Drink at least 64 ounces per day of filtered, spring or well water between meals (at least 20-30 minutes before or 2 hours after eating). Use cold pressed extra virgin olive oil, coconut oil or organic goat butter or ghee as your primary cooking fat, with sea salt and herbs for seasoning.

Foods to limit or avoid altogether include:

• Processed foods high in sodium, chemicals, refined (white) flours, gluten, soy, cane sugar, partially hydrogenated fat, as these substances all exacerbate PMS symptoms and cause weight gain, as well as other health problems. 

• Commercially raised meat, eggs and milk products from hormone and antibiotic medicated animals confined and not fed their natural clean diet. Depending on your symptoms, you may need to avoid dairy completely. 

• Caffeine found in coffee, black tea, soda, chocolate, and combination over the counter drugs to relieve menstrual cramps such as Midol.

• Alcohol, smoking, and street drugs.

• Toxic cosmetics and body products, household and workplace chemicals, plastic food containers and packaging, pesticides.

• Mind altering medications like sedatives, tranquilizers, sleeping pills, antihistamines and steroids, even common antibiotics and over the counter medications like acetaminophen and ibuprofen unless absolutely and medically necessary. You can aim for a medication free life as much as possible.

Investigate natural alternatives to medications. Acupuncture, Chinese herbs and homeopathy have provided relief to many women with all types of menstrual problems. They are especially helpful if your PMS symptoms are recurrent, chronic and/or so disturbing as to interfere with your sense of health and wellbeing. Try the lifestyle changes and natural supplements and herbal remedies discussed here for a few months, track how you feel and marvel at how much better you feel.

Consult some of the many resources available that discuss how to make healthy but delicious changes in your diet at home and on the road, such as Eating Well for Optimal Health by Dr Andrew Weil and Dr. Kelly Borgan’s Mind of Your Own: The Truth About Depression and How Women Can Heal Their Bodies to Reclaim Their Lives. Wonderful wholesome paleo cookbooks include:

•  Well Fed: Paleo Recipes for People Who Love to Eat

• The Wellness Mama Cookbook: 200 Easy-to-Prepare Recipes and Time-Saving Advice for the Busy Cook

• Paleo Comfort Foods: Homestyle Cooking for a Gluten-Free Kitchen

•  Make it Paleo: Over 200 Grain Free Recipes For Any Occasion.

Make sure you are getting enough sleep at night, and rest during the day, and that you get plenty of fresh air and adequate exposure to sunlight during non-peak hours. Weather permitting, spend at least 20 minutes outside with nature in the early morning or late afternoon sun each day.  Allow time for enough sleep at night and rest during the day.

Regular exercise does wonders to prevent and relieve PMS symptoms. Take a brisk walk, dance or an aerobics class, swim, hike, cycle, play tennis, or do whatever moderate activity you enjoy for at least 30 minutes 5 times per week. Authentic yoga has many added benefits, such as enhancing deeper relaxation, inner balance and improving general well-being. I suggest trying a few studios to find the best fit for you, taking regular classes as well as creating your own yoga sanctuary for home practice.

SUPPLEMENTS FOR PMS

For general health and physical and emotional well-being, make sure to take the supplements here that include a whole food multivitamin, omega threes, probiotics, Vitamin D, plus:

• Calcium, 250-500mg 2-3 times daily

• Magnesium glycinate, citrate or taurate, one of the most important supplements for women, 500-800mg 1-2 times daily (aim for approximately equal amounts of calcium and magnesium, or even double the magnesium, but you can reduce the magnesium if you get diarrhea, or divide the doses throughout the day with the capsules or in tasty powder form) and bathe in it before bed for 15-20 minutes, adding 1 cup Epsom salts to your bath for a restful sleep

• Vitamin B complex, 20-50 mg 1-2 times daily with methylated folate  

• Vitamin B12 sublingual (under the tongue), in the form of methyl, hydroxo or adenosyl cobalamin,) 1000-5000 mcg daily to 2-3 times weekly depending on symptom severity and blood levels

• Vitamin E, 400 IU 1-2 times per day (higher doses with premenstrual water retention and cramps)

• Curumin (Turmeric), 500 mg 1-3 times daily to reduce inflammation linked to depression, anxiety and other mental health challenges

• Evening Primrose oil, Borage or Black Currant oil, 500-1300 mg 1-2 times daily

• Maca powder or capsules to balance your hormones, stress response and relieve PMS

• DIM (Diindolylmethane), 25 mg of 25% diindolylmethane, from Brassicacae vegetables and/or Sulforaphane, 400-800 mg daily, or add Broccoli Sprout powder to your cooking to balance the estrogen dominance

Make sure you are getting enough essential fatty acids by taking 1000-2000 mg of the fish oil with 300 mg DHA/EPA twice daily, and adding the additional Evening Primrose, Borage or Black Currant oil all with GLA (gamma linoleic acid). Metagenics, Vital Choice, New Chapter, Innate Response and Nordic Naturals make high quality, trusted fish oil supplements, tested free of toxins and pollutants. But, as with all supplements, give a 6-8 week trial of continuous use to see results.

If You Have Troubling Emotional Symptoms

Implement the lifestyle changes and natural remedies for stress and emotions that apply not only in pregnancy but beyond, and certainly are critical for relief of troubling emotional PMS symptoms. Learning how to calm yourself and activate your relaxation response is key, using a regular practice of meditative breathwork. Biofeedback, energy medicine, hypnotherapy and self-hypnosis can also do wonders, but deeper transformative healing, release of stuck emotional and past trauma energy comes with conscious connected breathwork.

Spend more time outside in the sun as mentioned above, non peak hours, ideally without or low dose all natural sunscreen. If you do not spend at least 2 hours daily in the sun (a cloudy or winter day is sufficient), buy a full spectrum bright light therapy for the indoors, and expose yourself to 2500-10,000 lux two hours per day.

BALANCING EMOTIONS

Seek balance in your emotional life, instead of going for highs and the lows that follow. Surrender to and embrace the cycles of life and its ups and downs and ups again, and know that day always follows night, and light always comes after darkness. Nothing is permanent, including waves of emotion. Learn how to ride them, move them through your body with dance or breathwork, without getting too attached to any one feeling or the story around it.

Live one hour at a time, or better yet, one moment, one breath at a time. Become intensely conscious of the present, and acutely sensitive to your feelings and inner experiences, using all of your senses. Observe, watch and allow whatever comes up without judgement or thought.

Life is stressful and always has been, and eliminating all outside stress, especially that which we can not control, is not an option. We can only work on changing our outlook about stressors we cannot change. This involves deep profound and rewarding transformation, cultivating spirituality, and an attitude of surrender, acceptance, realizing that very little in life outside of our own way of thinking and behaving is in our control, and believing that everything happens for our ultimate benefit and growth as a human being, even if we do not understand why. 

RELAXATION TECHNIQUES

You can learn to activate your own relaxation response to stressors and quiet your nervous system with breath awareness and relaxation techniques, mastery over your thoughts, and also by modifying what you can in your day to make it less stressful and more in alignment with your core values. This includes, for example:

• Cutting down on the added nonessential burdens in your life, especially if you feel overwhelmed

• Avoiding overscheduling yourself

• Changing work hours to avoid rush hour traffic

• Allowing more time to get places

MINDFULNESS AND MINDSET

A wonderful life-changing approach to internal stress, feelings of depression and anxiety is learning about present moment awareness and mindfulness, and incorporating them into your daily life.

Know that you are in charge of the thoughts you dwell on, feelings and how you react to stressful or painful situations, and that you have the ability to change your attitude and reaction to life experiences to more health enhancing responses. For example, you can surrender to and totally accept unpleasant life events over which you have no power. You can also view them as potential gifts, powerful stimulus to change, a wake-up call, an opportunity for personal growth, redirection and spiritual practice. 

You can always try to focus as much attention as possible on the now, literally without letting your thoughts wander and dwell into the past or imagined future. Mastery over your thoughts, attitudes and reactions can have a dramatic impact on your brain chemistry, balancing the hormones responsible for affecting moods and emotions, and preventing and even treating clinical depression and anxiety.

Reduce feelings of tension and increase feelings of calm centeredness and balanced grounding by taking a “healing interval” to meditate for 10-20 minutes 2-3 times per day. Sit comfortably and quietly. Keep your eyes closed and internally focused between your eyebrows or softly gazing at a low, still object or place (like where the floor meets the wall). Turn off the mental noise and think and do absolutely nothing. Simply be aware of your breathing in all its details, the present moment and everything that you notice within it. If you get lost in thought, simply bring your attention back to watch your breath.

Tap into your spiritual self and practice slow deep abdominal breathing, yoga (especially Yin, gentle and restorative), QiGong, Tai Chi, progressive muscle relaxation techniques (yoga nidra), visualization and guided imagery, or cutting edge stress reduction audio programs and courses. For example, imagine you are in a place where you feel whole, inner joy and peace, and spiritually connected. Or think of a healing or rejuvenating spiritual energy or light flowing through and around you. This is an essential, yet easy to learn, tool with endless benefits and rewards to your physical and emotional health. Locate your nearest Zen Center (Zen is NOT a religion and does not conflict with any religion) or read any book by Thich Nhat Hanh, Pema Chodron, or Shunryu Suzuki to learn the basics of meditation and Zen practice.

Listen closely to your body’s messages. You may need to either slow down or become more busy with things that bring you deeper satisfaction and enrichment. You may need more time for yourself, or you may need to focus more on giving or helping others. It is extremely beneficial to find a small way to help someone in need each day, by giving your time, energy and presence to ease the burden and increase the happiness of even one person. Focus on connections with family and friends, healing relationships, making peace and giving love.

Try to make a conscious effort to increase feelings of forgiveness, appreciation, love, joy, optimism and healing, while letting go of anger, resentment, envy, fear, sadness and negativity. Most importantly, increase your awareness of anxiety provoking, tension causing, or depressive thought patterns that are not serving you. Try to shift your attention to something more positive and ultimately change your mental state. You can actually transform them at their deeper subconscious roots with Clarity breathwork. 

Mastery over your thoughts, attitudes and reactions can have a dramatic impact on your brain chemistry, balancing the hormones responsible for affecting moods and emotions, and  preventing and even treating clinical depression and anxiety. 

BREATHWORK

Start with breath awareness - being more conscious about your breath, and simply focusing all of your attention on your breathing. Get curious about all the details of your sensations as you inhale and exhale, without trying to change anything. Notice what you are currently seeing, hearing, smelling, feeling, tasting. Just watch without judgment. This brings you to the present and is deliciously relaxing. 

Then, sit up straight but comfortably, with your eyes closed, internally keeping your gaze between your eyes, or open and focused on a nonmoving distant object or place. You can do this reclining, as long as you are not likely to fall asleep - the point is to be conscious throughout.  While breathing be mindful, and just observe and release any muscle tension working your way slowly from head to toe. Practice Ujjai breathing. This is done by breathing at the pace and depth that feels right for you, but by inhaling through your mouth or nose, directing the breath into the back of your throat which makes a sound like ocean waves. I think of it like a calm, slow, and smooth circular version of gasping on inhale and fogging a mirror on exhale. This is meditation, combined with the benefits of breathwork.

Before going to bed at night, as well as before rising in the morning, periodically throughout the day, and whenever you feel stressed, triggered, down or upset, practice the following 3-part breathing exercise: 

• Exhale slowly through your mouth with an audible sigh while consciously releasing any and all muscle tension.

• Imaging a pump expanding your abdomen and lower back as you breathe down deep into your belly.

• Allow ribs to expand with air, then inhale air into your upper chest towards your collar bone and shoulders. 

• Inhale in this way for a count of 4.

• Hold for a count of 4 while staying relaxed.

• Exhale slowly through your mouth for a count of 4, releasing in the same order as the inhale, collapsing/returning to baseline, your abdomen, ribs, then upper chest.

• Repeat this cycle a total of 8 times or at least a few minutes. This is the ideal form of breathing, as opposed to rapid shallow breathing. With each exhale, let go and relax more. 

Once you get the hang of it, play with various types of breathing. Try  several minutes of inhaling and exhaling, each to a count of 3, 4, 5 or 6 without the hold, keeping it smooth and even. Then double the length of exhalation. For example, so if you inhale to a count of 3, then exhale to a count of 6. 

See how it feels to triangle breathe for a few minutes:. Inhale for a count of 3 or 4, exhale to the same count of 3 or 4, then pause for the same count of 3 or 4, while consciously and deeply relaxing your diaphragm muscle of respiration, as well as all other muscles. Repeat for several cycles.

Then see how it feels to box breathe. To do this, inhale to a count of 3, hold for a count of 6, exhale for a count of 6, hold for a count of 3. Repeat for several minutes. Many love this type of breathing so much they do it as often as they can, such as while waiting, in transit, before rising in the morning and going to sleep at night. 

Another great breathwork technique that disengages your conscious attention from thought and relaxes the nervous system, and can be done any time (like when traveling, waiting in line, resting, bathing, or on the toilet) is forced exhalation. After a normal breath, try squeezing as much air out as possible using your intercostal muscles, then allow breath to come in naturally and deeply, but automatically. Repeat the cycle for several minutes.

These breathwork and relaxation techniques are simple to do, health enhancing, totally safe, and without side effects. If you need more personal guidance, schedule a session with me. 

CREATE A FORTRESS OF POSITIVITY AND INSPIRATION

Minimize time online, especially addictive stressful apps, social media and computer games. Try to stay away from things (like certain books, movies and news), situations and people (like those who are angry, stressed out, negative, pessimistic, critical, fearful or demanding) that agitate your mind, raise your internal tension, bring you down and worsen your emotional state. If someone who you are close with continually criticizes, belittles, demands or negates your feelings, try to give positive straightforward suggestions about approaches that would be more helpful to you, or consider having this person come with you to some professional counseling sessions. 

Surround yourself as much as possible with calm, centered, and positive people, things, sounds and places that inspire, uplift, relax and restore you to inner peace and serenity. Treat yourself to a massage every week, bring more art and music into your life, try to allow time each day to do something you enjoy, and something that makes you laugh. Collect 4-8 hugs per day. The emWave personal stress reliever from the Institute of HeartMath is a wonderful hypnotherapy and biofeedback tool to lessen your body’s reactions to stress.

WHAT’S YOUR BODY TELLING YOU?

Listen closely to your body’s messages as your body is insanely wise. You may need to either slow down or become more busy with important things, or things that bring you deeper satisfaction and enrichment. You may need more time for yourself, or you may need to focus more on giving or helping others. It is actually extremely beneficial to find a small way to help someone in need each day, such as by giving your time, energy and presence to ease the burden and increase the happiness of even one person. Focus on connections with family and friends, healing relationships, making peace and giving love.

It is important to be open and honest about your feelings to yourself and to share important ones with your partner, a close friend or family member, or a professional therapist if needed. Suppressed emotions are ultimately more damaging and they can cause all sorts of physical, psychological and relationship problems if not properly dealt with. It is also essential to periodically release pent up emotions with a good cry, followed by a good hug. Do not hesitate to tell this to your friends and family so they can be more sensitive to your needs. Join a holistic PMS support group and discuss familiar experiences, share feelings, and discuss problem- solving techniques.

For persistent symptoms, make sure to have your provider check a comprehensive thyroid panel with thyroid antibodies, your vitamin D and B 12 levels, fasting glucose and hemoglobin A1C and address issues accordingly. Do what you can to address the root of your symptoms and minimize underlying possible causes. Some women benefit from natural bio-identical progesterone two or even three weeks before the period starts. Discuss with your holistic provider about prescribing it using a compounding pharmacy. Read renowned integrative psychiatrist Dr. Kelly Brogan’s Own Your Self: The Surprising Path beyond Depression, Anxiety, and Fatigue to Reclaiming Your Authenticity, Vitality, and Freedom and take her life changing online course Vital Mind Reset.

HERBAL SUPPORT 

There are a variety of herbal formulas that combine some of the herbs listed below, or you can try them individually. Many of the favorites are in my online holistic apothecary under the PMS, menstrual cramping and adrenal support category. It may take several months to notice a beneficial response, so give it time as you are working on your lifestyle. 

Common herbs recommended include Chaste Tree (Vitex), 2-4 dropperfuls 1-2 times daily of the tincture or 1-2 capsules dried herb, up to 500-1000 mg daily, or Don Quai, 1 dropperful tincture or 2 capsules up to 500-1100 mg daily twice daily. 

Physician, midwife and herbalist Dr. Aviva Romm advises additional herbs like: 

• Black Cohosh, 2-4 dropperfuls of the tincture, or 40-80 mg capsules 1-2 times per day

• Peony (which is many of the herbal PMS combinations)

• Adaptogens to support your stress response, regulate blood sugar, increase calm energy, and general well-being like Asian ginseng and American ginseng, Eleuthero, Schisandra, and Ashwagandha, 2-4 dropperfuls of each tincture or 1-2 capsules twice daily

• Dandelion root, Milk Thistle, Artichoke and Curcumin (Turmeric) to support liver clearance of excess hormones, and detoxification. HerbPharm Liver Health, Now Liver Refresh and Gaia Liver Cleanse are excellent combinations.

You can use any of these herbs to calm and support premenstrual emotional stress type symptoms, to relieve insomnia, headaches, and avoid constipation.

For Bilateral Cyclic Swollen or Tender Breasts, Bloating and Water Retention

In addition to everything mentioned above, implement any of these strategies as relevant to you, to reduce bloating and swelling.

Ditch the underwire tight fitting bras (most of the time).

Regularly massage your breasts and chest gently with Almond or Arnica oil to encourage lymph drainage. You may want to ask a massage therapist for guidance. 

Apply a Castor oil pack on your breasts for 1 hour 3 times weekly  to prevent and treat menstrual breast tenderness, but not during heavy bleeding. Soak a large piece of cotton or flannel cloth with cold pressed Castor oil, fold it so it is about 4 inches or layers thick, apply to your breasts and cover with a non toxic eco-friendly plastic bag. Apply heat over it using a hot pack, hot water bottle or heating pad, then cover with another towel. Lay down on a waterproof absorbent pad and rest with it in place for 60 minutes. You can reuse the saturated cloth several times and wash as needed.

Keep well hydrated with plenty of water, as it helps to clear the excess fluid you are retaining. If you do not usually use caffeine, and are interested in a natural diuretic, drink black or green tea regularly premenstrually. Cornsilk tea and Parsley tea are also effective and without caffeine - drink 1 cup 2-4 times per day. And eat more parsley, watermelon, cucumbers, celery, beets, garlic, lemon, cranberries and other natural food diuretics 

Another safe herbal diuretic is Dandelion. Take 1-2 freeze dried 500 mg capsules 500 mg per day. If you need a stronger diuretic, try Hawthorne Berries, 500 mg per day of standardized extract during the time you have premenstrual bloating from fluid retention.

Some find that Vitamin C with bioflavonoids is also helpful. Take 200 mg per day up to 500-1000 mg three times a day premenstrually as needed and tolerated, and increase iodine in food by eating more sea veggies. Take Iodinde as directed if you are deficient. Take a homeopathic combination remedy Mastodynon for relief of breast soreness.

For Cramps and Low Backache 

Experiencing pain is humbling, and it can be a chance for personal growth. It can be an opportunity to practice techniques that will help with life and the inevitable pain that all experience at various points, as part of being human in this world. Techniques like breathing, mindfulness, befriending and relaxing into intense sensations. Pain provides a chance to learn patience, acceptance of normal bodily changes associated with pregnancy, and how to prioritize, delegate, let go of activities of overwork or those that create increased stress, and allow others to help.

Do any of the breathwork techniques discussed in the breathwork section, and throughout all the exercises, practice embracing, relaxing into and even magnifying intense sensations without the mental story about them. Can you make friends with discomfort and pain, instead of trying to escape, numb or fight them? Is there something that they can teach you? Get curious about all of their details, including the borders or edges, and parts of you that feels good, or does not have unpleasant sensations. 

Yes, there are remedies to help alleviate pain. But you will be amazed how effective this practice is, and how much it will help you to better cope with your cramps, as well as with the pain that is an inevitable part of being human. It is the suffering from the pain that is optional, so you can choose not to suffer.

In addition to the above mentioned diet and lifestyle changes:

• Eat more plant based and naturally fermented veggies (kimchi) like sauerkraut

• Stick to real whole organic foods

• Use and eco-friendly natural household and body products

• Eat more fatty fish, like wild Alaskan or Norwegian salmon

• Eliminate processed refined foods, partially hydrogenated fats, caffeine, cane sugar, gluten and dairy

• Limit red meat to low-fat cuts

. Many women report much relief after a few weeks of making these dietary adjustments.

Remedies to start before the cramping:

Apply a Castor oil pack on your lower abdomen for 1 hour 2-4 times weekly  to prevent and treat menstrual cramps, but not during heavy bleeding. Follow same instructions as mentioned above.

Add several drops of one or combination of the essential oils Lavender, Rose, Ginger, Cinnamon, Clove, Marjoram and or Clary Sage into a bottle of Almond or Arnica oil and massage them into your low abdomen each day, starting 1-3 weeks before your period. 

Start or expand on key supplements in addition to those mentioned above like omega threes and calcium/magnesium. Take probiotics as directed, up your vitamin D to 2000-4000 IU depending on blood levels, add 100 mg of each of Vitamin B1 and Vitamin B6. Also consider Vitamin E (in the alpha tocopherol form), 400 IU per day, and Vitamin C, 1000-5000 mg per day a few days before and during the cramping. During the days of heavy cramping, depending on your dietary intake and the severity of your symptoms, you can take 100 mg of Magnesium Glycinate every 2-3 hours up to 1000 mg. Too much magnesium may cause diarrhea in sensitive individuals, but loose stool is a welcome sign if you have been constipated. 

To reduce inflammation and relieve pain, take Curcumin (Turmeric), 1-2 400-500 mg capsules, and Ginger, 1-2 capsules or 500-1000 mg each 1-3 times per day. Also try, Ceylon Cinnamon 2-3 capsules (has been researched effective using up to 3000 mg day) starting the week before your expected period. These are as effective as many over the counter medications, so you can also take it when you feel cramping during the first few days of flow.

Remedies for cramps:

Try modalities for general aches and pains as relevant to you now.

Use organic disposable pads, reusable cloth pads or a Diva menstrual cup when you have cramps...it lessens cramps!

Taking an Epsom Salt bath with a few drops of any of the essential oils Lavender, Rose, Ginger, Cinnamon, Clove, Marjoram and/or Clary Sage, and also put them in your room diffuser.

Rub Menastil on the skin over the lower abdomen. Afterwards, apply locally a hot or cold pack, heating pad, hot water bottle, herbal infused hot or cold pack, or try moist heat using a hot damp towel or packs from a hydrocollator (what the professional chiropractors, massage and physical therapists use). Thermacare makes portable disposable heating pads you can wear. 

Use a TENS unit.

Drink Red Raspberry leaf and/or Chamomile tea as much as you like. You can make your own infusion by adding a handful of Red Raspberry leaf or a pinch of Chamomile to 1 qt boiling water in a glass canning jar, covering and steeping Red Raspberry for 4-8 hours or Chamomile for 15-20 minutes. Strain, then add fresh lime or lemon juice, mint leaves or a dash of honey to taste (optional). Another great herbal combination is Earth Mama Period Tea. You can also take Red Raspberry leaf capsules as directed. 

Take two dropperfuls each of Cramp Bark, Black Haw and Motherwort, with ¼-½ dropperful of Chamomile tincture in a little water or juice every few hours.

Another herb that is helpful for painful cramps is Don Quai, 2-4 dropperfuls of tincture 2-3 times per day or 2 dried root 500 mg capsules 2-4 times daily. It can be taken up to every 4 hours in some cases, but only in consultation with an experienced herbalist, doctor of traditional Chinese medicine or integrative holistic practitioner, as there are some safety concerns and herb/drug interactions. 

Black Cohosh can be taken in lower, or higher doses depending on your unique situation, but an average dose in capsules to take is 250 mg 2-4 times daily, or 1 1/2 dropperfuls of tincture a few times per day. 

Try the Chinese herb Xiao Yao Wan with Bupleurum as directed.

Dr. Aviva Romm also reports success with:Valerian (1 capsule) 225 mg first few days, - best taken at night, as it can make you sleepy, and Fenugreek 900 mg 3 times daily. She is a wonderful, trusted, and well respected resource for natural remedies and herbal medicine as a physician, midwife and herbalist, and has much to offer regarding effective alternative modalities and herbs for pain relief.

Get a menstrual or mayan abdominal massage. Initially, you may want to consult a massage therapist, although eventually your partner may be able to learn some of the basics. 

Other effective alternative practitioners you can consult include specialists in homeopathy, yoga therapy, Shiatsu, reflexology, energy work, hypnotherapy and guided imagery, acupressure and acupuncture, and traditional Chinese medicine.

If you still need an over the counter medication and you are not planning a pregnancy, take one aspirin with food each day during the week BEFORE your cramping begins, to reduce the production of substances called prostaglandins responsible for cramping during the actual period. If the cramping is still uncomfortable when your period comes, acetaminophen (Tylenol), aspirin or ibuprofen (Motrin) can be taken as directed for relief if needed on a rare occasion, but it really is less toxic to avoid these medications which are not as benign as we have been led to believe, and use the natural alternatives instead.

For additional resources, read Women's Bodies, Women's Wisdom (Revised Edition): Creating Physical and Emotional Health and Healing, by beloved integrative holistic OB/GYN Dr. Christiane Northrup and Wellness Mama - ‘an online resource for women and moms who want to live a healthier life...fact-checked by our editorial and research team and reviewed by medical advisors for accuracy.’

For any natural remedy you use, give a two to three month trial to see how it affects you. Do your own research. Just because it is natural does not mean it is safe in any amount or combination for you to take. When in doubt about herb and supplement dosing unique to you, interactions, side effects and concerns, or you simply need more personalized guidance, consult your holistic or integrative medical provider, seasoned naturopath, herbalist, or If you need personal guidance, don’t hesitate to arrange with me an online coaching call or an in person holistic gynecology appointment. 

Contact your practitioner if these suggestions do not help, especially if your PMS symptoms are severe enough to cause you significant personal or interpersonal difficulties, if your symptoms do not go away after the first few days of your period and/or last throughout most or all of your cycles, if your symptoms persist or worsen despite trying these suggestions, if you are at risk for harming yourself or others, abusing drugs or alcohol. 

RELATIONSHIP WITH YOUR PARTNER & SEX POSTPARTUM

Relationship Issues

Having a baby, while associated with immense joy and euphoria, is a major life change for both you and your partner, and can affect you both individually and as a couple. Although it can bring couples much closer than before, postpartum can be challenging for your relationship with your partner, even if it was wonderful before and during pregnancy. And all the more so if there are ongoing difficulties and unresolved issues between you. 

Your partner may be going through a variety of personal emotions, such as:

• Recovering from the intensity of labor and birth

• Questioning their performance and ability to provide sufficient support for you and the new baby

• Fatigue from lack of sleep and doing a lot of extra work around the house

• Struggling with an increased sense of responsibility and finances 

• Anxiety over you and your baby’s well being

• Balancing outside pressures from work 

• Taking care of their own health needs

• Conflict regarding new role as a parent, especially if they had issues with their own parents

• Guilt about not being able to completely fulfill professional responsibilities or meet your physical and emotional needs

It is a time for healing and integration for your partner as well, and they may also feel overwhelmed, stressed and exhausted. Although you need lots of care and support, your partner may also. Tensions can escalate, so be mindful of doing what it takes to minimize or diffuse them. It is important each day to spend even just a few minutes alone to talk, laugh, hug, have a good cry if needed, and let each other know you appreciate and love each other. Individual or couples counseling by a holistic qualified therapist or life coach may be needed down the road, and have helped many adjust to this major life change in healthy transformative ways. 

Postpartum Sex

It is normal to have a decreased interest in sex for several months after having a baby, but once you are ready there are ways to navigate the journey and reclaim your sensual sexual relationship. It is safe to resume sexual intercourse when the vaginal bleeding has stopped, after the perineal area has healed, and after your 5-7 week postpartum checkup is normal.  

Suggestions to make your postpartum sex life better are to:

• Communicate your temporary limitations to your partner. Be honest and tell them how you are feeling.

• Include your partner in the postpartum experience since they often feel left out.

• Until you feel comfortable having intercourse, just cuddle, kiss and spend some sensual, affectionate time together doing recreational activities you enjoy. Focus on the pleasure of being together. 

• Practice mula bandha exercises several times per day to strengthen your pelvic floor (see instructions here).

• When ready to try intercourse, plan a date together with your partner when you expect the baby to be sleeping. Be prepared for occasional interruptions and keep your sense of humor. Remind them to be gentle as it may still be tender inside.

• Use extra lubricant. Explore the various natural scented and unscented sensual massage oils and see which one you like best.  

• Experiment with different positions. Try being on top, or a pillow under your buttocks with you on the bottom for comfort.

• Take Maca powder or capsules to support a healthy stress response, balance hormones and enhance your sex drive

Seek help if the sexual problems between you and your spouse run deeper than this, if you have worsening pain during sex, or if your discomfort or lack of sexual desire or feelings do not resolve over the next few months. Remember that if you are interested in preventing another pregnancy at this time, or if you feel that you cannot handle having another baby so soon after this one, do not resume intercourse until you have discussed contraceptive options with your practitioner. Whether or not you are breastfeeding, you can become pregnant as early as five weeks postpartum.

 As always, if you need more personalized support and guidance, schedule a chat with me so I can advise you about the best supplements, remedies and dosages specific to your situation.

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Premenstrual Syndrome (PMS) Part 1

Premenstrual Syndrome (PMS) is very common, as it has been observed and described throughout the ages and across cultures. Although most women experience some degree of physical and/or psychological changes in association with menstruation, the symptoms and their severity vary greatly for each individual. So if you have PMS, you are not alone!

PMS is described as the experience of a wide variety of symptoms that occur 1-2 weeks before, and sometimes through the first few days of your menstrual periods. These symptoms can include:

• Lower abdominal cramping

• Backache

• Bloating and weight gain

• Swollen tender breasts

• Nausea and diarrhea

• Appetite changes and food cravings

• Pimples, rashes and mouth sores

• Headaches

• Joint pain

• Stuffy nose

• Dizziness and decreased coordination

• Cold sweats and hot flashes

• Palpitations and nervousness

• Depression and crying

• Insomnia

• Poor concentration, forgetfulness, brain fog and indecision

• Irritability and mood swings

• Outbursts of anger and aggression

Numerous theories have been advanced to explain why PMS occurs. Although many of the symptoms are simply manifestations of the normal hormonal changes that occur throughout the menstrual cycle, an individual woman‘s response to these PMS changes depends a great deal on her physical and emotional health, as well as her mindset. Cultural background is a significant factor, since there are a variety of chemical and nutritional imbalances, lifestyle factors and psychosocial components that help determine the degree to which the symptom is perceived and identified as a problem.

PMS can be worsened by: 

• Hormonal medications and contraceptives, which can often lead to depression among other symptoms

• Past or current depression or anxiety

• Increased stress

• Inadequate sleep

• Excess body fat

• Decreased exposure to sunlight 

• Caffeine, smoking, alcohol and drugs

• Nutrient deficiencies 

• Chronic toxic exposure (from high use of chemicals and wifi in modern living)

• High consumption of dairy from hormonally stimulated cows

• Foods high in sugar, refined white flours and partially hydrogenated fat that creates blood sugar imbalances 

• A diet low in real whole food like fruits, vegetables, nuts, seeds, healthy protein, whole grains, and essential fatty acids (present in flax, fish, olives, borage and primrose)

• Modern isolating, high-tech, corporate living that disconnects us from ourselves and others, and makes our normal experiences abnormal

• Prevalent societal attitudes that include fear, numbing, medicating or escaping symptoms of discomfort as opposed to being with them, surrendering, welcoming, honoring them, listening to and finding meaning and beneficial purpose in their messages 

The drugs commonly prescribed to help alleviate the uncomfortable symptoms of PMS not only are expensive with potentially dangerous side effects, but also have not been demonstrated to work better than a placebo in well controlled studies. Remarkably, some have not been carefully studied at all for this purpose.

Stay tuned for next month’s blog for what you can do naturally for PMS.

If you need personal guidance, don’t hesitate to arrange an online coaching call with me or an in person holistic gynecology appointment.

INITIAL POSTPARTUM CARE AT HOME: YOUR COMPREHENSIVE GUIDE - PART TWO

POSTPARTUM CARE AT HOME: YOUR COMPREHENSIVE GUIDE TO THE FIRST FEW WEEKS - PART TWO

Do see last month’s blog for Postpartum Care at Home: Your Comprehensive Guide to the First Few Weeks - Part One.

Dealing With Postpartum Exhaustion

Welcome to motherhood!  Caring for a newborn and recovering from childbirth is no small task.  Fatigue can easily lead to exhaustion, infection, irritability and depression if you do not listen to your body’s signals for increased rest during this time. 

The best way to minimize fatigue is to spend the first two to four weeks after birth (longer after cesarean) caring only for yourself and your baby, while someone else (like your partner, a close relative or friend) tends to the other needs of the household. No need to feel guilty for doing nothing other than resting, taking care of you and your baby during this time. This is your sole job right now, with nothing else on your plate. 

Many of the suggestions for fatigue in pregnancy still apply, but other suggestions specific for postpartum to prevent exhaustion include:

• Eat well, at least three whole food varied healthy meals and snacks, without skipping meals

• Drink at least 8-10 glasses (64 ounces) of water daily

• Take recommended supplements, to ensure you are getting all the nourishment not you need for yourself and your baby while you breastfeed and recover, that is not supplied by diet alone. 

• If you are anemic or had excessive blood loss after birth, be sure to take herbal iron at least for the first 6-8 weeks postpartum, until you feel back to yourself and your labs including iron stores are normal. 

• Try to plan so that for the next 2, ideally 4 weeks, someone other than you is doing errands, cleaning, preparing meals for you and your family, and tending to the older siblings.

• Consider hired help (such as a mother’s helper or postpartum doula, a cleaning lady and even a personal chef or healthy meal delivery) if you do not feel you have enough support, or after your support leaves. This can be put on your online baby gift registry and is much more essential than stuffed animals, toys and an oversupply of newborn clothes Baby will soon grow out of.

• Be honest and direct about communicating your needs. Don’t be afraid to delegate responsibilities to others.

• Gratefully accept offers to help. Remember this is not just a much needed time to heal from the birth, but it is also a sacred time to get to know your baby and learn to breastfeed. As long as you are well supported, allow yourself to enjoy this special time and bask in the loving support of others.

• Rest, sleep and lounge as much as possible during at least the first month postpartum. Nap when Baby naps and ask a friend or relative to take the older kids for even an hour or two each day so you can do this. When you have a choice between folding the laundry or doing the dishes and napping, choose napping. Do not give into the temptation to do any housework, errands, childcare or cooking, as these tasks can be delegated to others during this time while you are recuperating. This is not a time to be supermom. Allowing yourself this extra time to rest now, will help you stay well physically and emotionally for you and your family, and will help you feel back to yourself sooner.

• Be strict with visitors. Don’t be shy about suggesting when it’s best for them to visit or excusing yourself if you feel tired. Ideally, put a sign on your front door saying something like,

“New moms and babies need lots of rest and help. We are resting now, please do not disturb. But, we would love a short quiet visit between {insert baby’s most awake hours}. If you would like to stay longer, please bring or cook a meal, play with our older children, or do some housework like the dishes or laundry.”

• Ask your partner to tend to the baby at night after you breastfeed for burping, diaper changing, settling, or holding skin to skin. Once breastfeeding is well established, your partner can also give the baby a bottle of expressed breast milk for one of the night feedings.

• Keep night feedings dark, quiet and boring so that baby will eventually learn to sleep longer periods of time during the night.

• If you can’t fall asleep at night, try these suggestions for insomnia, and make sure to take 1-2 daily naps or rest periods when the baby sleeps. Remember to silence your phone. Better yet, keep it out of the bedroom.

• Limit caffeine and avoid it after 4:00 P.M.

• Limit time on computer and iphone, and avoid it after dark.

• Get daily fresh air and sun exposure during the non-peak hours. 

• Treat yourself to a nice deep tissue massage focused especially on areas of aching muscles, or ask your partner to do it. A soothing simple combination for massage oil includes 3½ ounces Almond oil, ½ ounce Arnica oil, 15-30 drops of your favorite uplifting essential oils like Rosemary, Evergreen (Pine), Peppermint, Spearmint, Rose, Geranium, Ylang Ylang, Orange, Lemon, Citrus blend, Lavender or Jasmine. Shake well before each use, and store in a cool dark place in a glass bottle (this Almond oil comes with an extra 4 ounce travel bottle). A few drops of Vitamin E oil can be added to preserve it.

• After the first few weeks, an occasional weekend in a nice hotel with your partner and baby can be a really nice restorative rest and treat. And so worth the expense, as the hotel staff will clean your room and cook your meals!

• Practice regular yoga and light stretching any time. There are many ways to do it with your baby, or you may benefit more from having some space to do it alone, leaving Baby with pumped breast milk and a trusted sitter. Gradually get back into exercise in the morning or early afternoon after the first several weeks, and increase as tolerated after your bleeding stops and you feel up to it. 

• Do daily 10-20 minutes of conscious connected breathwork that provides you with natural energy and increases vitality. 

• Heed to signs of not getting enough rest, which include:

  • Ongoing exhaustion

  • Feeling run down and achy

  • Excess or prolonged bleeding

  • Inflamed clogged milk ducts

  • Frequent infections and colds

  • Excess emotional irritability 

Report to your practitioner if you cannot sleep, are too exhausted to cope, or your fatigue worsens or does not ease up by six weeks after Baby is born.

Excessive Sweating, Peeing and Shaking

A normal increase in perspiration and trips to the bathroom are common as your body rids itself of additional fluids that developed during pregnancy, and IV fluids if given during labor. Intense shaking right after birth is also common due to the hormonal fluctuations, temperature and body changes after the huge work your body just did to give birth. This is a normal stress response to release the intense energy that was involved.

Suggestions are:

• Ask your partner to hold you when shaking, but do encourage and embrace the shakes, without trying to stop your body from doing what it needs to do in order to reset.

• Take Rescue Remedy to support your normal stress response, if you feel you need it.

• If you are cold, wear absorbent all-cotton clothing and warm socks, dress in layers and cover yourself with warm blankets.

• For sweating and chills not related to infection:

  • Sleep on a large towel or terry cloth sheets.

  • Drink Ginger tea alternating with Cinnamon tea. It is best homemade, by adding a pinch of freshly ground ginger or a stick of Cinnamon to 1 cup boiling water and brewing covered for 15-20 minutes. Or a steep a stick of cinnamon in the water for a few minutes. Strain into a glass mason jar, add honey and or pure nut milk to taste.

  • For severe sweating, get an acupuncture treatment to balance your Qi and promote healing. 

Report to your practitioner persistent sweating that lasts several weeks, chills, muscle aches, and temperature over 100.4 after the first few days.

Dealing with Feeling Fat

This is one of the most common postpartum complaints. Women often struggle with body image issues postpartum, and feel fat. Typically, only about 12 pounds are lost with delivery, another 5 pounds are lost during the first week, and an additional few pounds are lost by the 6 week check-up. It can take several months for the fat stored around your hips and buttocks for breastfeeding and nourishing you during the pregnancy and postpartum, to be used up. So, it is good to remember that the calories used for breastfeeding will help you lose this extra pregnancy weight.  

The rest of the weight gained during pregnancy will have to be lost through a healthful diet and exercise program. Also, it takes at least 6 weeks for the uterus to return to a non-pregnant size, and it takes time and abdominal exercises to tone up the muscles and overlying skin that was stretched. It takes at least several months to return to your pre-pregnant size. 

Remember, breast milk production requires even greater caloric intake than pregnancy, as you are the primary provider of nourishment to your rapidly growing baby. So, this is definitely not an appropriate time to diet, as it deprives you and your baby of essential nutrients. If you gained excessive weight in pregnancy or were overweight before pregnancy, eating varied, whole food of high quality, and avoiding processed foods high in unhealthy fats, refined carbohydrates and sugars, and regular exercise when ready, is usually sufficient.

To summarize:

• Drink 64 ounces filtered, spring or well water daily between meals, at least 20-30 minutes before or 2 hours after eating.

• Eat a balanced, nourishing and varied diet high in:

  • Fresh organic fruit and vegetables

  • Organic tofu and tempeh

  • Beans 

  • Nuts, nut butters, and seeds

  • Organic pastured whole eggs

  • Organic free range, grass fed chicken and turkey, beef, lamb, and wild game

  • Wild Alaskan salmon and other fresh water fish from non polluted waters

  • Organic whole raw dairy-goat or sheep is best

  • Limited whole grains (sprouted is ideal)

  • Organic cold expeller pressed extra virgin olive oil, coconut oil, ghee or goat butter 

• Avoid foods that are heavily processed and loaded with unhealthy refined vegetable oils and partially hydrogenated fat, sugars, refined flours and starches.

• Begin regular exercise like brisk walking or dancing as soon as you are able and the bleeding stops. Aim for 30 minutes 4-5 times per week. Pilates is a great way to strengthen your muscles, and especially tone up your core. Yoga will tone your core as well, in addition to increasing total body flexibility and strength, and helping you calm and grounding feelings. Ideally, take a local class like mommy and me yoga or postpartum yoga and Pilates. There are also plenty of online classes until you can manage to get out to an actual class. Light walking, gentle yoga stretching, side lying leg lifts, pelvic floor muscle strengthening, and gentle abdominal toning exercises can be done after the first few weeks. Gradually increase time and intensity as you are able. Listen to your body, though. There is no need to rush or push yourself during this time of needed rest, healing and recovery.

• Historically and in plenty of cultures around the world, a fuller figure is more glorified, respected and honored, and being too thin is not considered healthy or attractive. While obesity is unhealthy and it is important to have a healthy weight and body image, there are many variations in normal weight and body characteristics. Ditch the pervasive media pictures of thin models. They are not realistic, they wreck havoc with body image and often result in you feeling unnecessarily bad about yourself. If you need to, look at the #BodyPositive images of mothers on social media. Be mindful of unhealthy thoughts from modern, western cultural stereotypes that imply “thin is most beautiful” and “looking fat is ugly.” Try to replace them with more true affirmations of pride and gratitude for your body having just grown and birthed your baby. Maintain acceptance and love for your unique body type which is forever changing. Know that you are more than just a body, but a beautiful eternal soul with your own special gifts, attributes and purpose far bigger than that of your body. Even though you are a postpartum woman who has just birthed her baby, you are also physically radiant, lovely, magnificent and have a deeper sort of beauty and wisdom.

Postpartum Depression and Anxiety

Intense emotions, mild depression, anxiety and mood swings are common in the first few weeks after having a baby, as are postpartum struggles. This is especially true if you are overtired and exhausted, without help or support from others, and/or have other stresses, personal issues or other problems. You may find that you are at times down, irritable, easily upset, extremely sensitive, cry without apparent reason, overwhelmed, tense, anxious, and unable to concentrate or remember things.  

Natural remedies to lessen the emotional ups and downs, and help you cope include many that are mentioned in my posts for managing stress and emotions in pregnancy. 

Suggestions specific for postpartum include:

• Minimize fatigue with the tips from the exhaustion section above. A - adequate sleep is crucial.

• Eat a healthy well-balanced diet as described above, but many feel best completely off gluten, dairy, soy and all forms of cane sugar. Consider eating an organic Paleo diet, an ancestral whole or real food way of eating high in pastured organic animal protein and healthy fat, plenty of fruits, veggies, nuts and seeds, with free use of herbs, spices and healthier sugars like raw honey. Try it for a month. You will be amazed how much better you feel physically and emotionally.

• For general health and physical and emotional well-being, make sure to take the supplements here that include a whole food multivitamin, omega threes, probiotics, Vitamin D, plus those specific for symptoms of anxiety and depression:

  • Calcium, 250-500mg 2-3 times daily

  • Magnesium, 200-400mg 2-3 times daily

  • Vitamin B complex, 20-50 mg once daily with methylated folate and 

  • Vitamin B12 sublingual (under the tongue) in the form of methyl, hydroxo or adenosyl cobalamin), 1000-5000 mcg daily to 2-3 times weekly depending on symptom severity and blood levels

  • Curumin (Tumeric), 500 1-3 times daily to reduce inflammation linked to depression, anxiety and other mental health challenges

  • Evening Primrose oil, 500-1300 mg daily

  • Continue your iron supplement if prescribed during pregnancy until you stop bleeding

• Take your encapsulated placenta pills as directed (see supplement section).

• Spend extra time breastfeeding and cuddling with your baby, skin to skin.

• Share your feelings with a close friend, relative, transformational life coach or integrative health professional. An occasional good cry does wonders, as does a good hug, and a good laugh. 

• Write and feel free to share your birth story. Include the details, the lessons you learned about yourself and others, your strengths you have discovered, how you and your partner have grown, and qualities you found that exceeded your expectations.

• Commiserate with other mothers by taking a postpartum yoga or exercise class, or joining a mothering, breastfeeding or parenting class or support group.

• Every day, remember to protect your emotional well-being by doing things that cheer you up and avoiding things that upset you.

• Each morning, shower, brush your hair, put on your usual make-up, and get dressed, even if it is just changing PJs or sweat pants and shirt. After the first two weeks, get dressed in clothes. 

• As soon as you are able and the bleeding stops, begin a regular exercise program such as brisk walking, hiking, low-impact aerobics, more active yoga, dancing or swimming for 30 minutes 4-5 times per week.

• Get out of the house and get some fresh air at least once daily, even for just a little walk in the park, a trip to the farmer’s market, or enjoying a cup of tea with a friend.

• Plan some leisure time away from the baby at least twice a week in the early weeks and more frequently later postpartum, even if just an hour each day.

• Avoid drugs, alcohol and caffeine. 

• Before attempting medication, try the recommended lifestyle changes, natural remedies and herbs for stress and emotions first, as they are non- toxic, effective and address the root causes, unless symptoms are too severe.  If you are already on medication, the natural modalities and suggestions here can be used in adjunct, and can ultimately support you when you one day taper down to lower doses and choose to stop taking them.

• For persistent symptoms, make sure to have your provider check a comprehensive thyroid panel with thyroid antibodies, your vitamin D and B 12 levels, fasting glucose and hemoglobin A1C and address issues accordingly. Do what you can to prevent postpartum depression and anxiety and minimize underlying possible causes.

• In Chinese medicine and many other ancient traditions, the dried placenta powder is recommended postpartum for its powerful healing properties, especially helpful for balancing emotions, prevent or lessen postpartum depression if there is a risk or history. Many doulas and birth professionals encapsulate placentas. If you encapsulated your placenta, take as directed by the provider who encapsulated it. 

Report to a healthcare professional if your symptoms of depression or anxiety worsen or last more than the first few weeks, if they interfere with your ability to carry out your daily tasks, if you notice significant changes in your eating and sleeping habits, if you feel desperate, hopeless, afraid, unable to cope, or have thoughts of harming yourself or your baby. 

Siblings

Postpartum is always a time of adjustment for siblings. It’s healthy and normal, and they each handle it differently. The youngest tends to have the hardest time, but not always. Some temporarily regress a bit. Some show upset towards mom, dad, or the new baby. Others become more needy and try to get negative attention and act out, if they can not get enough attention in a positive way. 

Although your heart doubles with each new baby, meeting the needs of the older children and balancing that with your own healing and newborn care can be challenging. Having a strong network of family, friends, mothers with similar aged children, or hired help is essential in the early weeks. This support system can help with the siblings’ care, give you time to heal, rest, and focus on the baby and mastering breastfeeding. Extra support is especially important if the sibling is a toddler or young child, as they usually need the most tending to. 

Take a deep breath and let compassion run through you, and imagine how you would feel if your partner just brought home a new girlfriend everyone's all excited about and loving towards, and encouraged you to love her too. Reassure them they are loved, give them a lot of approval, and include them in age appropriate ways if they are interested in helping to encourage them to feel involved and important. Try to spend some quality time with each of them alone regularly, so your attention can be focused on them completely without interruption, ideally after Bbaby has been fed and can be held by someone else. 

It is important to avoid expressing criticism or anger towards them when they are seeming to be acting out or trying to help, and do not suppress the expression of their feelings. A great book written in easy to read comic strip form, with great suggestions on helping older children adjust healthfully is Siblings Without Rivalry by Adele Faber and Elaine Mazlish.

If you haven’t already done so, get the wonderful book written by herbalist, midwife, and doctor Aviva Romm, Natural Health after Birth, for a more complete holistic and heartfelt guide to postpartum healing and wellness.

Need more help from me?

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As always, if you need more personalized support and guidance, schedule a chat with me so I can advise you about the best supplements, remedies and dosages specific to your situation.

My Natural Birth Secrets book 2nd edition is a great adjunct to the online Guide for postpartum and holistic modalities to common issues and discomforts.

For general postpartum healing: