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Bleeding in Pregnancy

 

Bleeding During Pregnancy - Why It Happens and What To Do About It

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Vaginal bleeding during pregnancy can often cause us to freak out and start thinking the worst. However, there are a multitude of less serious and more common reasons for light bleeding at this time, such as:

  • A burst of a tiny blood vessel in the vagina or cervix engorged from pregnancy hormones (especially with local infections, during the friction of sexual intercourse, internal exam or pap smear, and when there are vaginal varicosities).

  • Cervical polyps (often benign growths on the cervix that usually increase in size during pregnancy).

  • Hormonal fluctuations, especially around the time of usual monthly periods.

  • The normal implantation of the fertilized egg within the uterus (occurs 1-2 weeks after conception, around the time of your expected period, and lasts just a few days).

  • Bloody show at the beginning of labor (a welcome event only if your baby is at least 37 weeks, but more concerning if preterm).

Vaginal bleeding in the first trimester of pregnancy affects approximately 25% of all pregnant women. Less than half of these bleeding women actually miscarry. And once the fetal heartbeat is detected at the prenatal visit or on sonogram, miscarriage is rare and unlikely, especially in a healthy pregnancy where there is no prior history of problems like recurrent pregnancy loss. about 1 in 10 pregnant moms will have some bleeding in the third trimester. More often, the cause of bleeding is never found, the bleeding stops and the pregnancy continues to a happy conclusion.

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Vaginal bleeding during the second half of pregnancy can infrequently indicate potentially serious complications such as:

  • The placenta partially to completely separating from the uterine wall before birth (placental abruption).

  • A placenta that is located close to or over the cervix instead of higher in the uterus (placenta previa). A note of reassurance is that while approximately 45% of placentas are classified as “low lying” during the second trimester, the majority “migrate” upwards far enough away from the cervix by the third trimester, and are not a cause for worry.

  • The umbilical cord first inserts into the fetal membranes, then the exposed blood vessels without the protection of the cord travel to the placenta (velamentous insertion).

When To Call The Midwife or Doctor

You should be evaluated by your midwife or physician any time there is bleeding during pregnancy in order to rule out anything concerning or deal with something that is treatable. Call your practitioner if bleeding is light but lasts more than 3 days, is heavy like a period or a continuous flow (you completely soak through a regular sanitary pad in an hour or less), or accompanied by any of the following:

  • Pain in your pelvic area, abdomen, back or shoulder

  • Rhythmic uterine cramping

  • The passage of tissue or clots bigger than a 50 cent piece

  • Foul smelling discharge

  • A gush of fluid from the vagina

  • Symptoms of a urinary tract infection - like feeling you have to urinate frequently, but only little amounts come out, burning or foul smelling urine, low mid pelvic pain when you pee

  • Fever or chills

  • Decreased fetal movements

  • Weight loss, premature resolution of early pregnancy symptoms like nausea, vomiting, fatigue, and breast tenderness, or the return of your normal breast size

  • You have a history of ectopic pregnancy, miscarriage, molar pregnancy, placenta previa or abruption, or other significant health problem

  • You simply feel that something isn’t right

Once A Serious Cause of Bleeding During Pregnancy Has Been Ruled Out

Once you have been evaluated and the more serious causes of the bleeding have been ruled out or dealt with, you should do the following.

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  1. Make sure any issues that can be treated, like infections, MTHFR mutations or low progesterone, have been addressed.

  2. Do what you love, what brings you joy, and use your imagination to make routine tasks more enjoyable - even by turning on the music and dancing while you work.

  3. Take it easy and avoid heavy lifting until a few days after the bleeding subsides, with frequent breaks in a comfortable lounge chair, bed or couch.

  4. Limit non- essentials, delegate and ask for extra help from family and friends.

  5. Stock up on some good books, inspirational podcasts and movies, practice deep breathing and progressive relaxation exercises several times a day.

  6. Put nothing in the vagina (this includes no sexual intercourse) until 1-2 weeks after the bleeding has stopped.

  7. Eat warm foods, drink fresh ginger tea (steep a piece of raw ginger in a quart mason jar of boiling water for several hours), and limit cold and frozen foods

For a friable cervix that bleeds easily, small amounts of bleeding from a subchorionic hematoma, or persistent spotting from placental implantation, eat foods high in vitamin C. Good choices are citrus fruits, berries and dark leafy greens, as well as many other fresh produce. You may need to supplement with 500-1000 mg vitamin C with bioflavonoids, and add vitamin E (alpha-tocopherol)  400 - 800 IU daily for a few weeks only, to support stronger placental adherence to the uterus in early pregnancy. Chasteberry can enhance pregnancy hormones, and natural progesterone can be prescribed if levels are low in the first trimester. There are natural supplements recommended like whole food B complex with 2-3 mg l-methylfolate, and at least 400 mg DHA/EPA Omega threes for those with the MTHFR mutation, as well as low dose baby aspirin (81 mg) that can thin the blood enough to help it circulate through the tiny vessels of the early placenta without clotting, and prevent miscarriage if that is the issue.

If You’re Cramping But Not Bleeding

If all more serious causes have been ruled out, and you are simply having a lot of cramping without bleeding, make sure you are drinking enough fluids, and are getting plenty of calcium and magnesium in your diet. Start by eating lots of green leafy and seaweed veggies, ground sesame seeds (tahini), wild caught fish like salmon, almonds, whole grains, and organic yogurt and cheese. Avoid excessive cow dairy intake, coffee and soda, even spinach, which decreases calcium absorption. You may need additional supplementation - at least 400 mg magnesium and 1200 mg calcium daily in 2-3 divided doses; or make your own infusion of nettles and red raspberry leaf tea, using the recipe here.

Also, helpful herbs to reduce cramping are cramp bark, black haw, and wild yam. You can experiment with one of them at a time, or use all together in combination. Take 1 - 5 cc of each tincture every 30 minutes to few hours, depending on how often and intense the cramping is.

If There’s A Threat of Miscarriage

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Women can bleed and cramp and still have a healthy pregnancy. But not all miscarriages can be prevented. Miscarriage is actually pretty common, and rise with age and the more pregnancies a woman experiences. About 10-20% of women with known pregnancies miscarry before 20 weeks. Many miscarry around the time of the first missed period, before they even realize they are pregnant.

Heavy bleeding with cramping, lower abdominal or back pains and/or passage of tissue or fluid from the vagina during early pregnancy usually indicates that a miscarriage is in progress and there is little that can be done to stop it. In most cases, a miscarriage is your body’s natural way of rejecting an unhealthy or abnormally implanted fetus.

Once you know you are pregnant, it is still often experienced as a huge loss and the grief can be intense. I am sorry if that is what is happening and I encourage you to mourn as you need to, tap into your strength, look for the silver lining, and notice how you have grown as you heal.

Other less-common reasons for an isolated miscarriage include infection, dehydration, poor nutrition, severe trauma, and exposure to significant doses of hazardous substances (toxic industrial or environmental chemicals, drugs, alcohol, smoking, and radiation). It is still important to get evaluated, though, to be sure what is going on, and get treatment if needed..

If you have been informed that a miscarriage is threatening, follow the suggestions above for treatment of bleeding, plus:

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  • Drink a small glass of wine or beer, or a shot of whiskey in juice to lessen the cramping at night if interfering with sleep, but alcohol should be used in very limited amounts during pregnancy.

  • Keep well hydrated with plenty of fluids (at least 8-10 glasses of water daily).

  • Light some candles and take relaxing warm baths with your favorite essential oils.

  • Take 200 IU of Vitamin E 3-4 times per day for no more than 3 weeks to strengthen placental attachment and reduce spotting.

  • Take 500 mg of Vitamin C with bioflavonoids twice a day during the crisis period.

  • Do a yoga nidra, mindfulness practice or a progressive relaxation meditation to stay calm inside.  Whenever worrisome thoughts occur, use them as an opportunity to practice being present in the now and doing breathwork. For example, for 5- 10 minutes twice a day, do slow deep extended exhalation breaths (inhale for a count of 3, exhale for a count of 6), while allowing yourself to feel whatever you feel.

  • Tune into what is true for you, and what you really want. If it is your heartfelt desire to continue the pregnancy, let that feeling expand, as that will enhance whatever else you are doing. You can send loving thoughts to your baby and visualize your womb surrounded by love, light and spiritual protection; affirm that baby is welcome in your life, you and your baby are healthy and vibrant, your placenta is strongly attached to your uterus, you are providing safety, security and nourishment to your baby…as well as mama love, a love like no other.

  • You and your partner can place one hand on each other’s heart, the other hand on your womb, and imagine enhancing your family bond. Send love from your hearts to one another and to your baby. Focus on deepening and strengthening your love and connection, especially if there is tension between you. Never underestimate the close relationship of the mind and heart to the body, and the power of love and harmony to heal, and transform...and even prevent miscarriage if the pregnancy is healthy. This can be a wonderful opportunity of healing and transformative for all of you.

  • It helps to love yourself unconditionally and with compassion, to have a clear intention to release all self judgement and blame. Visualize the blame leaving you with each exhalation or melting away from your body, sinking down into the earth beneath you.  

  • Connect to other wise women, in sisterhood - those who uplift, inspire and support you. Have a good cry, a good laugh and a good hug several times a day.

  • It also helps to pray, and as much as possible. Then let go, surrender to what is greater and wiser than us all, the benevolent infinite, and release trying to control what is not in your control. Can we embrace what is, even when we do not understand the whys?

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If you are interested in herbal remedies to help prevent a threatened miscarriage, you can make your own infusion or tincture combination by mixing the following bulk dried herbs or the same herbs in tincture form:

Combine equal amounts of partridge berry, cramp bark, black haw, false unicorn root, wild yam, and chasteberry, with a dash of lobelia. Take 2.5 to 5 cc of the mixture every ½ to few hours until symptoms resolve, then a few times per day for a week. This mixture can be taken prophylactically twice a day in the first trimester, if you have a history of miscarriage in prior pregnancy. These herbs are said to aid the miscarriage if the fetus is not normally formed, but prevent it if it is strong and healthy.

Most of the supplements and herbal remedies I recommend are available on my customized online holistic apothecary. If you need more personal guidance, I am happy to help. You can set up a consultation with me here.

For extra support in pregnancy and relief of common aches and pains, wear an abdominal binder. Bellefit makes a fine one as pictured above. They also make postpartum support girdles . I have a holistic approach to life, including healing after pregnancy and birthing. Nothing replaces abdominal toning and exercise for restoring muscle strength and tone - which I encourage for all mamas as soon as they feel up to it postpartum. Nothing replaces touch, slow deep abdominal breathing, and a 'love your postpartum body' perspective that I promote.  But I have found many mamas simply feel comforted by this support garment, especially early postpartum and temporarily as needed....to be used without forfeiting abdominal toning and strengthening exercise, breathing well and touch. 

I have found Bellefit supportive garments to help like they use belly binding around the world such as in Indonesia. They do aid in early postpartum healing and provide support many mamas feel comforted by. I deal with human beings and the reality is many postpartum mom's struggle with body image, feel frustrated that getting back to themselves takes longer than expected.

Being into holistic health and healing includes being sensitive to real human struggles - the mind, body, heart and soul of each person and their unique situation. 

Having helped countless women with these issues after having a baby as a midwife, I have found many still love that binding and feel better with this support, and ability to fit into their pre-pregnancy clothes comfortably and sooner than they would if they went through a C-section or natural childbirth recovery without it - especially when they have to dress up and fit into a certain favorite outfit for a special occasion or wedding not long after having a baby.

For more info on the Bellefit girdle, check out my blog about it here.

 

Have a Great Pregnancy and Postpartum Recovery (with a little help from Bellefit)!

Again, you get a $20 Off with code: ANNE20 at checkout - if you purchase here.

 

Preparing for Pregnancy

 

There are so many things to consider when preparing for pregnancy

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Every momma wants to give her baby the best possible start in life. Preparing for pregnancy will enhance your own health for fertility success, and set yourself up to provide a healthy environment for your baby.

But, where do you start? Taking a natural, holistic approach to preparing for pregnancy includes optimizing your diet, supplements, physical movement and state-of-mind. This is a less invasive, less expensive, and much healthier approach for both momma and baby before even considering the standard fertility treatments.

Eating for a Healthy Pregnancy

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When preparing for pregnancy, it’s best to eat a wide variety of fresh, whole, plant-based foods and adequate protein. Your plate should be beautiful and colorful with plenty of varied vegetables, fruits, whole grains, beans, some nuts and seeds, seasoned with fresh herbs and spices. Look for:

  • Organic. Free of chemical fertilizers and pesticides that can damage fetal development, this is the best option for produce. Use the Dirty Dozen as a basic guide. These foods are to be either eaten organic or avoided.

  • Local. Choosing local typically means the food is at the peak of freshness, grown in your locality, maintaining more nutritional integrity.

  • Colorful. The various colors of fruits and vegetable provides differing nutrients. Make sure you’re eating a full spectrum of color to get a well-rounded diet.

  • Unprocessed. Chemical additives, preservatives, artificial sweeteners, food coloring and genetic modification can all negatively affect your health and your baby’s. If it comes in packaging, it’s probably not the best option.

  • Sugar-free. Sugar is damaging to you and your baby’s cells, and disrupts gut flora; it negatively impacts your pregnancy, and how you feel physically and emotionally. Sugar is found in almost all processed food. Look out for marketing tricks, like using four or five different types of sweeteners so manufacturers don’t have to list it as the first ingredient. Stick with natural sugars like in fruit, and if you must add a sweetener, a tad of pure raw honey or maple syrup is better.

  • Gluten-Free &/or Dairy-Free. Most women feel best when they are gluten-free. Try removing it from your diet for a week and see if you feel better in your mind and body, gain more energy or clarity. Many also feel better off cow dairy, but tolerate goat or sheep dairy products. Try a different week without it and note how you feel.

  • Hormone & Antibiotic-Free. Whenever possible, select the highest-quality organic meats and animal products, including wild fish from non polluted waters. If the animal food you’re eating was treated with hormones and antibiotics, your body and baby will be affected by that. And consider that most farm animals are fed genetically modified (GMO) corn and feed that is highly sprayed with pesticides. Animals who are free to move in the sunshine and graze in the green pastures, as they did for thousands of years before the modernization of the farming industry, produce the healthiest meat, diary and eggs for human consumption.

  • Healthy fats. Your body needs plenty of high-quality fat, especially when preparing for pregnancy. Ideally, you should be eating wild Alaskan or Norwegian salmon at least twice per week as well as healthy oils. Use extra virgin olive oil on cold foods (like for salad dressing) and light sautéing, and coconut oil or organic grass-fed butter for cooking at higher temperatures.

  • Hydration. Don’t forget to drink plenty of fresh spring or filtered water throughout the day. Work your way up to half your body weight in ounces. For example, if you weigh 150 pounds drink 75 ounces of water daily.

Preparing for Pregnancy with Supplements

In a perfect world, we would get all the nutrients we need from our food. But, with today’s industrialization of food and depleted soils, that has become virtually impossible. Additionally, the standard American diet is really empty of needed nutrition and even those of us with the best intentions do not eat all of what is needed for the health of ourselves or our pregnancies. The supplements you need when preparing for pregnancy will depend on your specific situation. Chat with me to find the best supplements for your body.

However, there are a few supplements that every woman should take daily. I take them myself and recommend them to all my clients. Following this supplement protocol has blessed me with feeling wonderfully vital and rarely getting sick - even when a bug is going around my house.

So what’s my supplement magic? I take whole food organic supplements from trusted, high quality, professional grade companies, including:

  • A multivitamin/mineral combination

  • Methylated folate in B complex

  • Calcium, magnesium, and D complex

  • Omega three fatty acids

  • Herbal iron depending on your iron stores

  • Mega-Probiotics that are colon and urogenital specific for women

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My online dispensary is a convenient way for you to purchase my hand-picked, professional-grade, whole food supplements and other natural health products. Ordering is simple by category (listed in the prenatal section), and the products will be shipped directly to your home or work within a few days.

For more details on food and supplements for pregnancy check out my Natural Birth Secrets book, and in even greater depth, my online course.

Exercise for a Healthy Pregnancy and Beyond

Movement is another important aspect of preparing for pregnancy. Not only will a strong, agile and flexible body provide a safer prenatal home for baby, it will help you avoid aches and pains along the way, reduce inner stress, help in labor and even postpartum recovery. The right exercise can also get your body ready to ease your baby into a perfect birthing position.

Ultimately, the best exercise is that which you enjoy, so you stick with it. Vary activities that you love, and incorporate it into your life so it doesn’t feel stressful. Here are some types of movement to consider:

  • Walking. This is a great place to start if you’re someone who currently isn’t getting much exercise. Begin with a leisurely 15-minute walk every day, and build up to 45-60 minutes at a faster pace.

  • Yoga. Yoga will not only strengthen your body and make you more flexible, it’s been known to decrease stress and enhance your overall well-being as well. There are tremendous health benefits to regular yoga practice. There are even fertility yoga classes out there, designed with just this topic in mind! I teach private yoga classes, including yoga workshops for pregnancy and labor, as well as postpartum - which can be done locally or on Skype.

  • Dance. Dancing is such a great way to keep healthy and active! It is so much fun, and is a direct path to feeling awesome without realizing you are also getting a fabulous workout. It relieves stress, helps you feel and move emotions, and creates happy for you, and for your baby; your stress hormones as well as your happy love hormones pass through the placenta to baby....and both are contagious to those around you. Dancing also helps you tap into your sensual or sassy sexy, which is beneficial in pregnancy, labor and life! Dancing in labor uses gravity and asymmetrical movements to ease baby down and out through a wider birth canal. Start by taking dance classes, but you can also just turn on the music regularly and dance like no one is watching. I give group and private healing movement workshops - called Femme!, which is a wonderful experience for both men and women.

  • Weight-training. If you are not called to yoga or dance, back, arm, leg and core exercises help align your body and are great preparation for the uneven weight of pregnancy. Squatting helps prepare for delivery.

  • Pilates. Pilates has a strong emphasis on core conditioning and is also great for mommas-to-be.

  • Swim. It gets you outside, connected to nature and immersed in healing waters that soothes the soul. Swimming and water aerobics are also great ways to be active. In advancing pregnancy, it relieves common aches and discomforts, and pregnant women love the sense of weightlessness they feel in water.

If you’re someone who currently has an intense workout regimen and are having trouble conceiving, consider dialing it back to a lower intensity. Otherwise, moderately moving your body and being active each day is the way to go.

Tapping into Mindfulness and Joy

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Reducing inner stress and living in joy are central to preparing for pregnancy. Inner stress can actually prevent pregnancy. Many of us recognize that we have grown out of alignment with our true natural being and it's time to get back to our original design.... get back in touch with the cyclic nature of our human bodies, our minds, our hearts and our spirits. The thoughts we think and the perspective we carry while preparing for pregnancy are incredibly influential.

Find ways to slow down, unplug and enjoy the journey. Make sure you are well rested, and getting 7-8 hours of sleep each night. Practice saying “no” to anything that doesn’t bring you calm and pleasure during this time. Explore ways to bring joy back into the things that aren’t optional. Stay as much as possible in the present moment, one moment, one breath at a time; practicing mindfulness - anchoring into what is going on around you and the sensations within you in the now transforms your life and will benefit your labor immensely. Consider a daily practice of mediation, journaling, and creating any form of art to help your body keep in a calm and joyful state. Decide to live a glorious life; dress and treat yourself like the goddess you are. Focus on what you have to be grateful for and all the blessings in your life. Connect more in community with those you love, and those who inspire you. Clear your body of trapped emotional pain, trauma and internal stress, and transform self limiting beliefs and thought patterns with Clarity Breathwork. Turn negative thoughts into positive affirmations, for example: My body is strong and healthy for pregnancy or I am the perfect age to become a mother; empowering uplifting thoughts are usually the opposite of, and more true than the false stories we typically tell ourselves.

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Acupuncture is a great way to relax and has the added bonus of hormone regulation and improved ovarian function. Many women who had some initial trouble conceiving often get pregnant after receiving acupuncture by a practitioner with expertise in fertility; I have seen it used in conjunction with routine infertility treatments, and have seen successful pregnancies even after several IVF attempts failed.

We’ve discussed a lot of lifestyle factors here. Some might be big changes for you. Don’t let them overwhelm you. I’m a huge fan of the 80-20 rule. Spend 80% of your efforts on achieving optimal habits and allow yourself the freedom to enjoy the other 20% without guilt.

Fertility Awareness

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Learn the signs of fertility so you can make sure you have intercourse during the small window of time when you are likely to conceive, you get the most accurate estimation of pregnancy dating, and you will even know when you are pregnant before you can take a pregnancy test. This is key, and will also provide helpful information as to causes of difficulties should you need professional guidance. I cover this in more detail in my Natural Birth Secrets book.

For further inspiration and optimal health during, birth and after pregnancy, please make sure to click here to take my online Love Your Birth course, so you can ROCK your journey wherever and however you plan to give birth.

 

RhoGam Shot in Pregnancy

 

Risks and Benefits of RhoGAM

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Many expecting parents have questions about whether or not to get the Rh immune globulin (RhoGAM) shot if the momma to-be is Rh-negative. This applies to a small number of women, but it is extremely important for them to be armed with all the information prior to making a decision.

If you are among the roughly 10 - 15% of people who are Rh negative, your pregnancy could be affected if your baby is Rh positive.  In this situation, obstetric providers often recommend RhoGAM.


However, it’s not always that simple. If you’re not sure you have all the information for an informed decision, you’re in the right place. Below are some frequently asked questions and points to consider.

What is the Rh factor?

The Rh factor is a protein that can be found on the surface of red blood cells. If your blood cells have this protein, you are Rh positive. If they do not have this protein, you are Rh negative. This is the negative or positive after your blood type: A, B, O or AB. It is simply about different normal variations in red blood cells. For example, you can be A positive or O negative. The negative or positive is your Rh factor. A pregnant woman will get a blood type, Rh and antibody screen as part of the routine prenatal blood tests; if she is Rh-negative, her antibody response will get tested several times as indicated throughout the pregnancy to check for Rh sensitization.

What is Rh incompatibility and sensitization?

Rh incompatibility is when the blood of a fetus is Rh-positive but the momma’s is Rh-negative. In this situation, if baby’s blood gets into mom’s bloodstream, the mother creates a defense system against the different type of blood; it is perceived as foreign by her body, even though it belongs to her baby. She will react against it by making anti-Rh antibodies. When a pregnant mother makes antibodies against the Rh factor on her baby’s red blood cells, it is called sensitization. Once a mom is sensitized, it stays with her forever.

This rarely causes complications in a first pregnancy, as the primary immune response takes time to develop and initially produces IgM antibodies that are too large to cross the placenta. However, it could be dangerous in future pregnancies for the fetus or newborn baby, when the secondary immune response is more rapid and the body has made smaller IgG antibodies that easily cross the placenta. Once these antibodies can cross the placenta, they try to destroy the fetus’s red blood cells.

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How can Rh problems affect the fetus during subsequent pregnancies?  

Rh sensitization can lead to a wide variety of mild to serious health issues in a fetus or newborn of the next pregnancy. The main concern is a severe type of anemia in the fetus, in which red blood cells are destroyed faster than baby can replace them. Red blood cells carry oxygen to all parts of the body. Without sufficient red blood cells, the fetus will not get enough oxygen, and this can result in hemolytic disease of the fetus and newborn causing jaundice, brain damage, heart failure and death.

How can my fetus’s blood get into my bloodstream?

During healthy pregnancy, a mom and her fetus usually do not share blood, thanks to the placenta that keeps the fetal and maternal blood circulation separate. But sometimes a small amount of blood from the fetus can mix with the mother’s blood. Typically, there is no mixing sufficient enough to risk sensitization unless there is are complications like miscarriage, placental abruption or previa, abdominal trauma, or an invasive medical/surgical procedure like chorionic villus sampling or amniocentesis, abdominal surgery and even ultrasound. 

Sensitization is usually associated with a rapid and large volume of fetal-maternal blood mixing. The most common time for Rh-positive fetal red blood cells to enter mother’s bloodstream, is during childbirth, though it can occur at other points during pregnancy - mainly in the third trimester.

Traumatic and difficult births with a high level of invasive procedures increase the likelihood for baby’s blood to mix with mom’s. So can certain routine interventions including use of the synthetic drug Pitocin to induce or augment labor, local or regional anesthesia, forced directed pushing, clamping the umbilical cord too early, pulling on the cord and putting pressure on the fundus to hasten delivery of the placenta.

A gentle birth process with minimal intervention and time allowance for the placenta to separate provides a reduced risk of significant mixing of blood between mother and baby.

While not a guarantee, planning for a natural undisturbed physiologic pregnancy and birth may certainly help prevent the mixing of fetal and maternal blood that leads to sensitization and hemolytic disease.

Can you tell if the baby is Rh-positive?

There is a new noninvasive blood test, which can detect fetal blood type using a blood sample of the pregnant mom. It is said to be highly accurate, almost as reliable as the conventional test, that uses a blood sample of the newborn after birth. It is almost, but not 100% accurate; and it is not available everywhere or covered by all insurances.

I recommend dad getting his blood type and Rh factor tested. If the father is Rh-positive and the mother is Rh-negative, there is about a 75% chance baby is Rh-positive, and providers will probably recommend RhoGAM. But if both parents are Rh-negative, baby will also be Rh-negative; in that case, there is no risk of Rh sensitization, and no need for RhoGAM.

What is RhoGAM?

RhoGAM is a drug made from human blood plasma, that prevents the mother from making antibodies against the positive Rh factor in baby’s blood. It is given via intramuscular injection, to prevent the immune response of sensitization against baby’s Rh positive blood, and subsequent hemolytic disease of the fetus or newborn in future pregnancies.

 
What are the benefits of RhoGAM?


RhoGAM’s effectiveness has been demonstrated in multiple studies around the globe. According to Dr. Murray Enkin et.al of A Guide To Effective Care in Pregnancy and Childbirth , one of the widely respected and authoritative founders of evidence based care, RhoGAM given after birth reduces the rate of hemolytic disease from 15% down to 1.6%.  RhoGAM administration prenatally in the third trimester has been shown in studies to further decrease the incidence to 0.06%.

The administration of RhoGAM medication to Rh-negative mothers is thought to be a major achievement of modern obstetrics by many in the medical profession. Before RhoGam’s introduction into routine practice in the 1970s, hemolytic disease of the newborn was a major cause of serious illness, death and long term disability in babies.

RhoGAM does not typically benefit firstborn babies unless the mom who is Rh negative has previously experienced a reaction to a mismatched blood transfusion, an abortion, miscarriage or ectopic pregnancy untreated with RhoGam.  

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When is RhoGAM recommended, and why?

For women who are Rh-negative, health care providers routinely recommend a shot of RhoGAM around 28 weeks of pregnancy and then again within 72 hours after birth, in order to protect the baby of a subsequent pregnancy.

Providers must decide about the RhoGAM shot and its dose based on how likely it is for the baby to have Rh-positive blood, as well as how likely it is for the baby and mother’s blood to significantly mix during pregnancy and birth.

Is there controversy around RhoGAM?

This standard approach is not without its critics, especially regarding its routine use during pregnancy, in which only about 1.5% of Rh negative moms with Rh positive fetuses develop antibodies and become sensitized against the baby’s positive Rh factor. Risk of sensitization is significantly higher after birth. Administration of RhoGAM postpartum is much less controversial, where benefits of the medication more clearly outweigh potential risks.

“The problem with routine prescription of prenatal RhoGAM is that many babies who are Rh negative like their mothers will be exposed to the drug, and there has been no systematic study of the long term effects of this product in babies.” - Ina May Gaskin

 “RhIG is not given for the direct benefit of the recipient or even her current fetus. The only beneficiary will be an RhD-positive fetus during a subsequent pregnancy (although the woman would also benefit in the event of a wrongly typed transfusion during the time of birth). Furthermore, prenatal prophylaxis unnecessarily exposes the 35% of fetuses who are RhD-negative to RhIG. These babies are at no risk of RhD sensitization. RhIG is completely unnecessary when a baby is the last child in the family. In the absence of clear answers to these pressing questions, the routine use of RhIG assumes that the birth process for RhD-negative women is inherently flawed.” - Anne Frye

Reliable research and meta analysis of the studies on benefit and harm of routine use of RhoGam in pregnancy are still limited, especially as it relates to who, when and which dose is needed, as well as its cost effectiveness.

Some argue that there may be other factors that contributed to the marked decline in severity and prevalence of perinatal morbidity and mortality associated with Rh incompatibility and sensitization, and medicating healthy pregnant women undermines those who trust the inherent wisdom in the natural process of childbearing. That being said, the issue remains an issue which, still today, impacts babies of pregnant women who are Rh negative.

What are the risks of RhoGAM?

Despite excellent results, the medication retains an FDA Pregnancy Category C: “Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.”

The known possible side-effects to RhoGAM include local swelling inflammation at the site, skin rash, body aches and sometimes hives. Infection from the blood product of modern preparation is rare, but still a possibility.

Expecting mommas should also keep in mind that standard RhoGAM preparation in many countries contains the mercury compound known as thimerosal, which has a litany of health risks.  However, pregnant mommas can request the use the mercury-free RhoGAM, if it is available where they live. In the United States, RhoGam is said to be mercury-free, although it may still contain traces.

So, is the RhoGAM shot absolutely necessary during pregnancy? 

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This is a hard question to answer for each individual person, on a blog.  Although much of the research is compelling, it is dated, was largely funded by the pharmaceutical companies and it is not without bias, flaws and some conflicting conclusions. For an eye opening text analysis of the data though 2001 and guidance from a traditional midwifery perspective, check out “Anti-D in Midwifery: Panacea or Paradox? 2nd Edition”, by Sara Wickham.

As always, pregnant mommas should empower themselves with knowledge and talk with their provider to fully understand the benefits and risks of all medications unique to their situation. 

I encourage my clients to take great care of themselves, be well-educated on their health-related issues, and to be in tune with their bodies.  While I aspire to provide evidence based information about medications and recommended treatments, I also know that there is much we do not know, and I am wary of routine medical and surgical interventions in a healthy natural process Too often they are widely used before sufficiently evaluated or harm has been identified. I feel informed and empowered moms are best able to make decisions for themselves.

Understanding that the vast majority of woman who are Rh-negative will not become sensitized during pregnancy, as it is rare that mixing happens until birth, is an important consideration when balancing the risks and benefits of using a pharmaceutical therapy while pregnant.

If you are Rh-negative and baby’s dad is Rh-negative, no, you do not need the shot. If baby’s dad is Rh-positive, and you choose to refuse the shot in pregnancy, you may still need it later if you suspect bleeding or another reason for sensitization, or if you change your mind. If you have done your research, you believe you are low-risk, and you do not feel comfortable with the shot while pregnant, do not let a provider pressure you. 

According to those who advocate a gentle birth process with minimal intervention and time allowance for the placenta to separate, there is usually less risk of significant mixing of blood between mother and baby. But mixing and sensitization can certainly still occur during healthy natural birthing. Traumatic, highly interventive and difficult births increase the likelihood for fetomaternal hemorrhage and sensitization. So can certain routine interventions including ultrasound, use of the synthetic drug Pitocin to induce or augment labor, local or regional anesthesia, forced directed pushing, clamping the umbilical cord too early, pulling on the cord and putting pressure on the fundus to hasten delivery of the placenta - anything that possibly disrupts the delicate physiology of placental separation or cause tiny fetal blood vessels to rupture and bleed. Planning for a natural undisturbed physiologic birth may certainly help prevent the mixing of fetal and maternal blood that leads to sensitization and hemolytic disease.

If you are feeling overwhelmed, or do not even know what questions to ask, I can help you! Check out my number one international best selling book Natural Birth Secrets and my online course - an online version of how I have helped thousands in my local practice. Both resources are unique, but each provide an in depth, one-of-a-kind holistic approach created by me, a seasoned nurse midwife of over two decades, who has seen everything!

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If you need more personalized guidance and help navigating these and other tough decisions, you can arrange a consultation with me, bundled with my online course. Or I invite you to choose from a variety of services I offer to the global community. Rock Your Journey To Motherhood is my most comprehensive, supportive offering for pregnant mommas anywhere in the world.  You will have personal access and guidance from me as we co-create your joyful journey from pregnancy to postpartum healthy bliss.

 

Birth Story of Redemption

 

“Redemption: Koen James

Stalking your Instagram and drooling over all things Birth!

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I wanted to share my story:

After experiencing a hospital birth and an at home intervention free birth I have such a deeper connection with my body and the things it is capable of. I find myself being in complete awe over what the woman’s body can accomplish by watching, scrolling, and reading stories into the wee hours into the early morning. An indescribable feeling.

Those who attended the birth of my first born would tell you it was unforgettable in the worst of ways. Two years ago, I was riding passenger on the way to the hospital to be induced. My husband and I discussed during our drive how delighted we were for our lives to change to a family of three to avoid the anxiety we felt. After a short ride we arrived to small talk and routine work: readying IV's, retrieving a catheter, sterilizing the area, the whole nine. Luckily I was contracting on my own the use of pitocin was unnecessary and went directly to breaking my water. Before leaving my room my doctor quickly questioned me about the need of an epidural. Although my pain was fear driven, I was young and naive, I insisted.

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Seconds after receiving the epidural I was reaping it's effects. I became so nauseated I couldn't bare to speak. I was begging for relief as they injected a dose of phenergan into my IV. Little did anyone know I was severely allergic to the medicine. I couldn't see. I couldn't talk. I began to black out. I woke up for a split second patting my chest in hopes to convey something was wrong. My nurse was frustrated unaware of the situation she got two inches from my face yelling "USE YOUR WORDS" repeatedly. All I could do was grab her arm with a frail grip before passing out again. My condition was worsening when I awoke for a second time. I remember looking up to my husband holding my hand, telling me it would be okay, as he began to tear. Everyone was being rushed out of the room as a team of doctors scrambled through the door. I didn't know it but my heart rate was dropping.

 Awake for a third and final time, it was over but now it was time to push. I was exhausted and still confused, I thought the oxygen they had me on was their attempt to put me to sleep. In between surges, with what little energy I had left, I was fighting to remove the mask. Two hours of nodding in and out, I remember asking if it was almost over. Anything that could have gone wrong, did. I was ready to be holding our baby boy. A tiny six pounds and twelve ounces, he was finally here. Relieved we're both okay, I still look back and break a little inside unable to recall the birth of my first child. 

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Once we became pregnant for the second time we knew, wherever we delivered, we would not opt for any interventions. It wasn't until the third trimester we started weighing out our options of where we would welcome our newest addition. I knew I didn't want to be in the same environment I was with my first, scarred from the experience we lived previously. It wasn't until then we discussed a home birth. No pokes and pricks, being in the comfort of home, I wouldn't have to find a sitter for our son, it appeared to be a dream. This is what I wanted. 

It was a day after my due date when my water broke as I was laying our son down for a nap. I immediately alerted my midwife, Rebekah, who was attending a birth of another mother. I then called out to my husband and informed him we would have a baby soon. We went about the rest of our day normally, trying to do the odds and ends in order to prep our house for birth. I continuously encouraged my husband to get as much rest as possible before going to bed myself.  

I was filled with mixed emotions as I attempted to close my eyes. Although this was my second birth it was very much my first. I didn't know what to expect as I had no previous experience other than reading what I could online. I woke up early Sunday morning with consistent contractions. I began timing them before I carefully crept out of bed trying not disrupt our son to go wake my husband on the couch. I could tell he had gotten little to no sleep. As I started to explain I needed his help timing my contractions he told me he didn't go to bed until five that morning.. it was three. Nodding in and out we averaged my contractions two minutes apart while lasting thirty five seconds. 

Keeping my midwife updated she decided it was time to head my way. They arrived just as the sun was making an appearance through the trees. She had brought along some back up, Paige a student midwife, as the rest of her team was still with laboring mother before me. As we got aquatinted my contractions stayed two minutes apart while lengthing in time. I was checked at five centimeters when Rebekah asked if I felt comfortable with her leaving to attend her previous engagement. I gave her the thumbs up as I tried to get comfortable for the labor ahead. 

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I was stretched across the couch when Paige encouraged me to get into a more baby friendly position to help descend him further into the birth canal. I put a pillow under each knee and squatted down while leaning over the seat cushions. I could feel my contractions intensifying as I was overcome by intolerable back pain. My husband would try massage me while Paige squeezed my hips, but it was doing more harm than good. I couldn't be touched. All I wanted to do was lay down. 

I crawled back up on the couch surrounding myself with pillows in every direction to give my body some ease. With each wave I would reach out to my husband and pull on his shirt until it passed. I had been laboring in the living room for a short couple of hours, since my midwives arrived, when I decided I wanted to try a new method of comfort and relax in a hot bath. Before stepping into the water, Paige checked me in between six and seven centimeters. She called Rebekah to inform her of my progression. Minutes away from reaching her destination she asked if she needed to turn around. Since my dilation appeared slow Rebekah continued on her drive.

My son was still asleep in the room next to me when I got into the bath. I immediately turned on the cold water. I was refreshed with the cooling sensation through the marathon my body was running. At this time my contractions were now a minute or more long. The pain I felt in my back had me paralyzed. I could do nothing but scream. I managed to wake our son from the howls I released through each surge. As much as I wanted him there I knew I couldn't comfort him like he wanted me to, so we quickly called for reinforcements. My husband attended to his side while Paige poured water over my forty week belly and reminded me that I could do this. I wasn't in the tub for ten minutes when I told her I needed to push. No one was expecting me progress the way I had. She asked me slightly confused "You need to push or feel like you want to push?" I shouted "HES HERE". 

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Before getting up to notify Rebekah, she wanted me to promise I wouldn't push. I knew it was no promise I could keep. Our son's ride arrived relieving my husband back to his former duty of being by my side. I had one more contraction in the tub when I demanded we make a run for it. I was caught in the hallway by another surge before reaching the couch. Rebekah was too far away. She would never make it back in time. It was just the three of us. With Rebekah absent, my husband and Paige rushed to get everything ready for the arrival of our newest baby boy.

I was already pushing as I watched them grab the rest of the necessities. I beared down against Paige who was positioned at my feet. Through all the pain I had felt that morning I was at such peace while pushing. With two more thrusts he was here. I lifted him up to my chest and rubbed my fingers across his face. He had the most perfectly round head and that beautiful burgundy after birth color. My husband cut the cord while I took everything in that I had missed the first time. I finally got the birth I had been longing for. I thanked my body for overcoming my mind and showing me what I was truly capable of.

I questioned myself on if I should write my story when I was reminded, I gave birth at home, after a traumatizing first experience, without any interventions, and that itself is a success. I could and I did and this time I remembered. 

@shelbylclowers’’ 

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Was your birth upsetting or traumatic? Do you have more questions about processing your birth and need help healing? Arrange some time to chat with me. I’d love to answer your questions and help you heal and get yourself back - I have a program specifically got you, that can also include this revolutionary and last natural healing modality called Clarity Breathwork.  Helping women heal from birth trauma is one of my passions and areas of expertise. So is preventing it in the first place.

This is why excellent childbirth education is a must, why planning for your birth is so important today, and is a major reason why I created my Love Your Birth course. It is a comprehensive online course that teaches women what they need to know about planning and carrying out the birth that they want in all settings - the hospital, birthing center or at home. It’s a course on how to have a holistic, healthy pregnancy for the body, mind, and soul - and is how I have guided thousands of women and their families in my midwifery practice for over 21 years. It contains a rolodex of my favorite resources with over 200 of the best books, movies and supplies I use personally and professionally with my clients, family & friends. Even diving into a fraction of this list will have you feeling empowered and prepared for conception, pregnancy, postpartum and parenting...It includes resources on improving and even ensuring ensuring healthier pregnancy and birth outcomes than the status quo, and preventing and healing from birth trauma so prevalent in the modern world!  Be prepared to do some research on your own, but knowledge restores your power. I also help you prepare your mindset for such a task, to debunk myths, and to reframe any current ideas or conditioning about pregnancy and birth that can use a change in perspective or that are simply incorrect and do serve you. After finishing the course, the idea is that you are now able to create and have the healthy, beautiful and empowering pregnancy and birth that you want - so you can ROCK your birth! It is a course that is recommended by doctors, midwives, and other professionals around the globe!

You can get a free nugget from my course - all about creating your ideal birth plan here. A huge part of preventing birth trauma is getting clear your birth preferences, knowing the pros and cons about all the tests and procedures, all the interventions your may be faced with, so you can make informed decisions - rather than simply give over your body, your choice and voice to your health care providers and institution you choose.

 

How To Build A Successful Midwifery Practice

 

What I Didn't Learn In Midwifery School

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As midwives, we go through years of college and post graduate education and clinical training. We learn a lot about women’s bodies and supporting the natural processes of puberty through menopause, of everything childbearing and breastfeeding. We learn to provide excellent midwifery care - the science and the art of it. We learn prevention and management of complications and emergencies, and to collaborate or refer to a physician, when we are presented with situations beyond our broad scope of practice.

Doulas take a short course to learn how to provide labor and postpartum support, what is needed to mother the mother during this special journey. These things are obviously necessary to a successful midwifery or doula practice. But how to run a thriving midwifery or doula business is not really included in our training. Unless you’re going to be working in a setting where you’re purely an employee with no administrative or marketing role, there are some key elements missing to our education.

For those of us who are called to accompany families through the incredible journey of nurturing and birthing new life into this world, there is no greater honor than when a momma tells us, “I choose you.”

Even after helping moms to give birth to over 1,000 babies, every time I am hired to provide holistic maternity care I am so grateful and so delighted. I know that I will be a part of a powerful experience for that family. Returning power to women, encouraging them to feel their vitality, live in joy and love their birth are some of the hallmarks of my successful midwifery practice, as are my holistic approaches to health and healing.

However, I didn’t earn the opportunity to support the successful births of so many beautiful babies or empower so many inspiring mommas by education alone.

Having a successful midwifery practice of 21 plus years has provided me with many resources and a lot of lessons that I wish I would have known when I first started.

After my education and training, I felt skilled as a doula, childbirth educator, and a midwife. I could help people heal and transform psychic pain with Clarity Breathwork; I could teach yoga for pregnancy, labor and postpartum, and for life. With much experience and ongoing deeper work, I knew I had what it takes to help mommas love their birth experience and I created an online course to share my local practice with the global community. Professionals around the world also take it, to help them help the mommas they serve. Eventually I could write #1 international best selling books on natural holistic birthing and healing emotional pain, trauma and stress so prevalent in the modern world!

On the other hand, I had no clue how to build a successful, thriving practice. I spent a lot of money and time taking many workshops and continuing education. I embarked on my own self-study to master and refine my skills as not only a midwife, but also as an owner of a private practice and its administrator. And I made A LOT of mistakes along the way.

Below are the key things I wish I knew before I embarked on my doula, and my midwifery journey.

10 skills you need to learn (even if you outsource) for a successful midwifery practice

1) Bookkeeping. Billing, collections, taxes, accounts payable. If you don’t have financial systems in place from the start, things can get pretty messy.

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2) Dealing with insurance. If you plan to accept medical insurance, there’s a whole world of claims, codes, and coverage that you need to understand.

3) Online Marketing. Between the ever-changing social media platforms, chat rooms and websites, online marketing can feel overwhelming. It’s important to learn how to stand out on the over-crowded internet.

4) Client paperwork. Making needed practice forms, legal documents, and informative handouts for clients is a must in every practice.

5) Charting. The most efficient chart forms vary from practice to practice. And charting challenging cases can be well...challenging.

6) Professional communications. As you grow your practice, there will be a variety of situations that call for written communications to other health care professionals. These include networking and forming collaborative relationships, thank you notes for excellent supportive care, and summarizing cases for consultations or referrals.

7) External Communications. These are letters written to individuals outside the health care team on behalf of expectant mothers as their obstetric care provider. For example, disability claims, approval for gym membership, dental work, or travel, insurance exemptions, as well as payments and appeals.

8) Team Management. As my practice grew, it became increasingly necessary to have clarity about the roles of other members in my practice. Birth assistants and administrative team members need clear protocols for things like handling emergencies and maintaining certain skill sets.

9) Supply Management. This may seem simple, but not having the right supplies for a care visit or a birth can be a real nuisance. Not to mention embarrassing!

10) Self-care. Setting boundaries in your practice for your own personal health and self-care is key to being the best you can be for everyone in your life - family, clients, and self.

Want to learn how I did all this and more (like how I consistently earn six figures)?

Whether you’re considering a career as a midwife or doula, getting your practice started, or an experienced birth professional looking to take your practice to the next level, my programs will get you where you need to be.

You can have a successful midwifery or doula practice, and I’m here to help.