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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.

 

WHAT TO DO WHEN YOUR BABY IS BREECH OR TRANSVERSE

WHAT TO DO WHEN YOUR BABY IS BREECH OR TRANSVERSE

Art by Catie Atkinson @spiritysol

Letting Go: Dying To Birthing - The Key To A Very Real First Time Mama's Homebirth Story

 

My birth story is currently gathering a lot of attention, specifically around my thoughts on home birth, and the rawness of what I learned about myself.

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Disclaimer 1: This was my first pregnancy and birth experience. I say this because I know my feelings around my journey are so much a reflection of it being my first time.

Disclaimer 2: All birth is birth, and all people who birth babies are badasses. I chose a home-birth experience because it most reflected the journey that *I* wanted to have, based on my personal value system. Please don’t let my passion for home-birth make you feel that any other path is not as powerful.

Disclaimer 3: Don’t let my story shape your narrative of birth. Every birth is different, and pleasurable births are possible. In fact, here’s an interview I did about Orgasmic Birth just days before I went into labor. I believe that some mothers manifest the birth experience they need for whatever lesson they are walking at that time. I believe God is reflecting back to her in those moments the things her heart most needs to look at. For those that could use healing in regard to their birth stories, I highly recommend a Birth-Processing session with my midwife, Tiffany Hoffman, through Alchemist Movement's healing sanctuary. 

Disclaimer 4: I was blessed with a healthy pregnancy, and privileged with access to healthcare and a steady income, and this is what made me successful in my home-birth dream. Even though home-births cost about $10,000 less than hospital births (and that's without a C-section), they are rarely covered by insurance. I hope my story helps spread the gospel of birthing at home.

Act I: The Mind Fuck (36-40 Weeks Pregnant)

36 Weeks: You feel like an expert in pregnancy but a complete novice in labor/birth (for first time moms, at least). At this point in my journey, because the impending labor just didn’t seem real, the whole thing felt like an exam I was studying for but that there was a chance I might get out of. Like, you’re nervous for the test, but also the Professor has shared he might just cancel the finals and base your final grade on your most recent paper, or something.

39 weeks: The reality of your birth, which absolutely no one knows how it will unfold, is definitely just around the corner. Because I was planning a natural birth and natural induction, the whole thing just felt like a surprise party that I accidentally found out about; I knew a party was happening, but I didn’t know when or where. So every corner I turned (every strange feeling), every time I walked in the door (every new pain), I’m like, “Is this it? Is it happening now?” And then it’s not, and the mind fuck just continues. You know you’re at the end, but also you’re still going...

40 weeks: “The Surprise Party” is now all the time. Basically everyday I was sending group texts like, “IT’S HAPPENING.”... ”No wait sorry no it’s not, my bad everyone.”...  “OK NOW FOR REAL!”... “oh shoot sorry no it went away sorry.”

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Act II: It’s Really Happening (Labor begins)

On Monday of my 40th week, I kept thinking my water broke because I was constantly leaking fluid due to incontinence (#LoveRealLife). There are these swabs that test for amniotic fluid, and my midwife gave me a handful of them to take home because it just kept happening. (Did you know that only 8-10% of women’s waters actually break in early labor? Most don’t break until right before the baby comes out. The idea that water breaks early is just an overused Hollywood trope!) The reason it was important for me to know whether or not my water was still in tact was because I had tested positive for GBS (1 in 4 women do), and, in the case of my water breaking, I had 18 hours (or something like that) to get the baby out in order to keep his risk of infection low.

I went through several false swabs throughout the week, then...Friday morning, February 9th, at 8:30am I went to pee and felt a little rush of fluid. At this point I had every expectation of another false result, when suddenly, the tip of the swab turned a vivid blue/black. My heart did flip-flops. I texted a picture of the swab to my midwife, and within seconds she wrote back, “Yep. That’s a positive swab. Your water has broken.”

A strange mixture of both calmness and adrenaline washed over me. It’s really happening, I thought.

I walked out and told my husband that my water broke. We both felt grateful that our baby decided to begin his journey on a Friday, giving us a 3-day weekend to capture the experience (it seriously could NOT have been better timed).

Typically, labor starts naturally within 12-24 hours after your water ruptures. My birth team and I decided that if my labor hadn’t started by 6pm that night, I was going to drink a “castor oil smoothie” (a natural way to induce labor at home). I texted all my friends and we decided to have a “castor oil smoothie party”. I was nervous because I really wanted to let my body progress naturally without the smoothie, but I was also ready to get the show on the fucking road.

I went about my day as normal. I even got a text from a producer I work with a lot, and she needed me to record a voiceover for the film we had been working on. I wrote back, “No problem. My water just broke, so send me the script within the next couple hours and I can knock it out.” She replied, “Can I please screenshot this text and send it to our client? You’re fucking insane.” To which I replied, “No, I’m dedicated.” But also, early labor can be mentally brutal, so having normal things to do was always a part of my plan, anyway.'

I did the voiceover. I went for a walk with my husband. We kept having these mini existential crises like, “Babe. This is our LAST walk as a family of two. Next walk we take there will be a BABY.”

At 6pm, all my friends had gathered for our castor oil smoothie party. We had pizza and donuts and were ready to rock out in my living room. Then...the midwives showed up. Another mama had gone into labor, and they asked me to NOT drink the smoothie, because it can speed up labor REALLY fast, and they can’t be in two places at once. So, they ran a few tests on me (checked heart rate of baby, took my blood pressure, and gave me an IV of antibiotics as a guard against any infection from the GBS).  

The new plan was that they were going to rush off to the mom currently in labor, and then text me at midnight; if my labor hadn’t progressed by then, I was to drink the smoothie at midnight, giving them enough time to take care of that mama, and then get back to me.

I felt bad, like I had ruined my friends’ plans (this is a theme that would come up majorly throughout the next 22 hours). BACKSTORY: My midwife had been emotionally preparing me for 6 months, “You labor as you live,” she would tell me. What does that mean? It means that whatever emotional battles you fight in your life, THEY WILL ARISE TO THE SURFACE DURING A NATURAL LABOR! This is why having a natural labor was so important to me -- because it presents one of the most powerful opportunities to heal yourself of old patterns and wounds. It sets the space for absolute, total self-awareness and alchemy to occur. For me, that meant people-pleasing and trying to control everything, and then feeling really bad when I couldn’t. More on that later, though.

My friends, being the amazing humans they are, obviously didn’t care. We hung out and ate junk food, and my doula taught us some belly dancing moves. So, there we were, a bunch of girls, gays, and a pregnant chick, belly dancing in early labor on a Friday night. Around 10ish, it was clear that a baby wasn’t coming any time soon (contractions hadn’t even started yet), and so my friends went home, and I watched the clock, waiting for midnight and preparing my smoothie.

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At midnight, my midwife texted me, “Almost done here. Go ahead and drink the smoothie, if it feels right.”

IF IT FEELS RIGHT -- those words seemed to stick out in bold on my text screen. Why did she text “if it feels right??” I wondered.

So I asked, “Why did you say, ‘If it feels right’?”

“Because you don’t have to drink it if it doesn’t. Does it?” She asked.

NO. It didn’t. It didn’t feel right. And I’ve never in my life, even as a professionally trained psychic (whatever that means, right?), *heard* something as clear as the “no” I got when I read her text. And this is why I am and will always be so in love with Tiffany Hoffman, my midwife, because she also listens to the Universe, and she knew to text me that.

I wrote back, “It doesn’t feel right.”

She said, “Great. Don’t drink it. Try to get some sleep. See you soon.”

The house was quiet. My friends were all gone. My husband was sleeping. I felt depressed because I JUST wanted to GET THE SHOW ON THE ROAD. But I couldn’t deny that “no” I felt/heard. It was just so...loud and clear. I went and laid in bed. There was no way I was going to fall asleep. What’s going on in there, I wondered to my baby.

At 12:30am my bff, whom I lovingly call “Wifey”, texted, “What’s going on?”

“Nothing, really,” I answered. “All the sudden I just got these really bad period-like cramps. I’m just laying in bed in the fetal position.”

“Be there in 10,” she shot back. She showed up a few minutes later with a heating pad. We went to my living room and I laid on the floor as the period cramps got worse. I was in the fetal position and she was cuddling me. Just typing this part of the story is making me super emotional. I’ll never forget that hour, just her and I on my floor. I texted my doula who showed up around 1:30am. My bff went to lay down in my bed to sleep, and my doula took over cuddling me on the floor, rubbing my head, talking to me about what was happening. The pain was gnarly, so my doula texted the midwives and said things seems to be progressing rapidly.

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The midwives arrived around 3:30am, I think. They had spent all night at that other birth. I texted my friends and told them to come back around 6:30am. My plan (which is laughable now) was to have all of my tribe present when the little King made his entrance. I had also made a private facebook group from which I was going to broadcast my labor live. Over the course of my final month of pregnancy, that group had grown to about 60+ people, all friends and family near and far. Again, my intuition screamed at me, “Don’t do it. Don’t broadcast this to that many people.”

I had been watching live births on a Facebook group called “BirthTube” for weeks, and felt really attached to the idea of letting all my favorite people be a part of this experience in such a modern way. But no, my insides were telling me not to. So, in the middle of a contraction, I created a new group with only a few people in it (parents, my husband’s family, and a couple of important friends that I really just wanted there). I also insisted on no one even knowing I was in labor, and flipped out when I found out my husband had posted in a small, private theatre group that my water had broken. For whatever reason, I could suddenly *feel* the energy of people thinking about us, and I then understood why mammals seek privacy when giving birth. I went from wanting all of my loved ones to know things had started, to not wanting anyone to know until it was over.

My mom, who was 3 hours ahead of us in Ohio, called me and said Azlan had come to her in a dream. That it was super real and that she had even seen his face. She said in the dream she was showing him off to our family, including my great-grandmother Orpha, who I’ve had an extreme psychic connection to since I was a baby (including talking to her in my dreams as a very little kid, and knowing things I couldn’t have otherwise known). My mom said in the dream I was walking around looking for donuts to eat, which was hilarious and validating because I was absolutely walking around eating the donuts my Wifey had brought over the night before.

5am: I got into the birth tub in my living room for the first time. You’re supposed to wait until the last minute to get into the tub, when you can’t handle any more pain,  because it provides so much relief. If you get in too early, it can make it less effective later. I was so convinced that I was so close to the end at this point and wanted to be in the tub. (More backstory: in 2009, when I met the man who would become my husband, I had a vision of a waterbirth in a living room, with him sitting behind me. This was before we were even together. This psychic vision was so intense that it actually made me go, “Hmmm...well, he IS kind of cute. I could see him being my babydaddy.” That vision then created the crush that then made me pursue him.) So, needless to say, I was convinced this is how my baby would be born, and I wanted in that tub.

While I was in the tub, my friends had the MOST INCREDIBLE jam session. They were playing worship music, and my favorite singer in the whole wide world was belting out my most favorite worship songs while my husband played piano. Then they had a drum circle, which was amazing to hear while in labor, and really helped me to tap into Earth energy. This whole part is so fuzzy to me, and I remember not being able to look at my friends because I felt so self-conscious. Turns out I only like the spotlight when I’m in absolute control of everything happening under it.

7am: I was antsy and annoyed that “nothing was happening”. I felt like I was disappointing people, that I was “taking too long”, that I wasn’t performing, that my friends were bored, that my birth team was annoyed. I was more worried about being a good host and was absolutely incapable of tapping into my own needs and focusing on myself. (Are you seeing now how all of my personal issues were arising in my birth, full frontal, completely raw. It was impossible to not be aware of them). My midwife 10000% warned me this would happen, and so I knew in my heart what was going on inside me. 

My birth team suggested that I get out of the tub and sit on the toilet for a while. By this point some back labor had started and I was miserable. It fucking hurt to sit on the toilet, but also I could see how SO many women give birth on toilets because of the muscle memory that comes as soon as you sit down. Like, I had so much trouble relaxing my pelvic floor and “letting go”, even in the tub, but the second I would be on the toilet, I felt comfortable relaxing “down there”. But also it fucking hurt to sit on a hard seat.

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I want to take a moment to talk about my doula, Allison, who was the most amazing thing to happen to my birth. I would never have another baby without a doula. I called her my shepherd, since that’s exactly what she was for me throughout my journey. While my midwives were busy charting and executing their medical role, and my friends were just trying to hold space, my doula never left my side (unless I asked her to). Every time I peed, every time I changed rooms, every time I cried..she was right there, affirming me, telling me stories of  other births, promising me over and over again that the pain would stop the very moment the baby came out.

At this point, I hadn’t been measured yet, and didn’t know how far along I was. Part of going the midwife/homebirth route is that they are very hands off. It’s all about trusting your body, trusting the mother, and trusting the baby. The medical reasons for not checking for dilation are because it GREATLY increases chances of infection (especially in cases where the water has already ruptured). It’s actually kind of crazy that this practice has become normal in hospitals because the research is all there of how much more risk it creates. The psychological reasons for not checking is because it can really put the mother in her head if she’s not “as far along” as she thinks she “should” be.

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But by this point I was going a little crazy and needed to be checked...for my own sanity. Again, the midwife journey is about honoring WHAT THE MOTHER WANTS, and guiding her to have autonomy in her choices. So, though many midwives discourage checking the cervix, when I was clear about wanting it, I got it. I decided that if I was anything less than 8cm dilated, I was going to send my friends home. So, my midwife checked me, and the result was 6cm. I started crying and finally admitted that I needed my friends to leave because I just couldn’t surrender. I am a people-pleaser, and a control freak, and there was zero chance I was going to be able to tap into my primal nature with anyone watching. I asked my doula to go tell all of my friends (except the one who feels like my big sister) to leave while I cried in that bathroom, grieving the loss of the birth I had so carefully “planned” in my head.

9:30am: They suggested I try getting into bed. Again, I had a ton of emotions around this not being a part of my “plan”. My beautiful, wonderful midwife took it upon herself to move all the “affirmations” I had taped up in my living room to my bedroom. I hated those affirmations at that moment. “Fuck the affirmations,” I kept thinking. The only thing good about this part are how beautiful and raw the pictures are from my husband and my doula in bed with me.

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10am: I made Tiffany check me again, I was 8-ish cm.

11am: I tried to overcompensate for the guilt I was feeling about how long this was taking by showcasing a suddenly fresh and invigorated attitude. It became clear that the baby’s position was not great. He was head down, but the awful back labor and slow-ish progress also indicated that he may be mal-positioned. Luckily for me, my doula happened to be familiar with something called Spinning Babies, which is ALL about creating better births by creating better positioned babies. My doula had told me I should be doing these exercises throughout my whole pregnancy, ESPECIALLY third trimester. Here I was, with probably the only doula in town with this knowledge, and I didn’t do it. I assumed that because he was head down that I was totally good to go. I regret that so much, and if I ever had another baby, I would spend my entire pregnancy focusing on this aspect. But it was too late now, so all I could do was try to do some moves in the moment, including deep lunges up my basement stairs, and a weird upside thing that hurt so bad I only achieved one.

12pm: The back labor was so bad at this point, I was so miserable. The ONLY thing that provided relief was sitting slouched on my couch. But here was the kicker: every time I sat like that, I undid all of the progress from the lunges. I literally had to CHOOSE to stop doing the one thing that was bringing me any relief. And here’s why midwives are the heroes of our planet: they never told me that I had to stop slouching. They only suggested it. I remember Tiffany actually saying, “You can keep doing it, we’re not going anywhere, but it is slowing your labor down. We support you no matter what.” Can you fucking believe that?? A doctor in a hospital would probably be like, “I’ve got a golf game at 4, so you need to hurry up.” But here was my birth team, letting me have my journey. I just don’t have words to capture how incredible, humbling, and boundary-pushing that was.

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1pm: My contractions stopped. WHY. GOD. WHY. Emotionally, I knew God was challenging me again and bringing up my people-pleasingness. It was KILLING me knowing that my midwives had come from an overnight birth. I knew they hadn’t slept yet. I knew that I had called them too early. I felt like I failed them, that I should have known I wasn’t as far along as I thought, and that they could have gone home to sleep after the birth from late Friday night. I kept begging them to go take naps in our guest room. And I kept apologizing that I was “taking too long”. I seriously was so triggered by this aspect. It was almost as unbearable as the physical pain. And no amount of loving affirmation from them that everything was fine would help.

Anyway, midwives can’t administer pitocin to stimulate contractions (outside of the hospital), so they used herbal tinctures and nipple stimulation via a breast pump, which are known natural stimulants.

It wasn’t working.

4pm: No urge to push yet and really pissed off about it. I was crying and begging Tiffany to “tell me when it would be over.” I felt like I could handle the rest of the journey if someone could just FUCKING TELL ME how much longer it would be! Even if someone was like, “You’ve still got 8 more hours of this shit,” I would have been like, “Awesome. Someone start the clock.” But not knowing how much longer I had was existential torture like no other. Was it 2 more hours? 5 more hours? 2 more days?!?! The physical pain mixed with the emotional distress of not knowing made me want to die. It was sometime around here that I asked for a gun so I could shoot myself. (Dramatic, I know. But I was NOT planning on this back labor, and I was NOT planning on it taking this long.)

At this point my lovely brother stopped by to take our senior dog for a walk. I remember that he walked in, and so casually and genuinely said, "You're still in labor?"

I. almost. murdered him. He will never live that down.

5pm: More lunges, more stairs, more resisting the urge to recline on the couch, more crying, more begging, more praying and pleading and bargaining with God. One thing that I swear worked is that I kept bargaining with my baby and making deals with him that if he wanted to be born at home, things needed to progress.

6pm: My husband took his third nap. I remember telling myself that I would be very supportive of him napping because he would need his rest and should seize it when he could, but oh my god I was SO FUCKING ANNOYED by this time and resented him for even being able to sleep at all. I’m only noting this because it’s funny and true.

Also, at the time, we decided to discontinue my IV. This was another moment of intuition where I could simply FEEL that I didn’t need it, and that my baby and I would be okay without it. Also, there was something about that contraption being lodged in my hand that was seriously holding me back. I can’t quite describe it but I felt so free when they finally took it out.

Asynclitic

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6:30pm: Midwife noted that the baby felt asynclitic, which refers to the position of a baby in the uterus, such that the head of the baby is presenting first and is tilted to the shoulder, causing the fetal head to no longer be in line with the birth canal. This would explain the excruciating back labor and slow progression.

7pm: I asked to go to the hospital. All the passion I had for having my baby at home was gone, and I just wanted it out of me. Despite there being absolutely no medical concern for me to transfer (heart rate, blood pressure, etc), I had so much fear that I just wasn’t going to be able to do it. My contractions had stopped. In my head I felt like I wasn’t progressing. And though the pain was insane, it was more that no one could tell me when it would be over, and I just wanted to give up.

Of course my midwives supported whatever I wanted to do, but they also knew I was fine, so they encouraged me to understand what transferring would mean, and I realized that it wouldn’t really solve any of my problems (as it was probably too late for an epidural, plus I would have to deal with checking in, etc). The idea of leaving the energy of my home and dealing with the energy of a hospital seemed absolutely impossible. My midwife actually bargained with me, which was a BRILLIANT move on her part. She said, “Let’s check you again, and see if you’ve progressed in dilation. If you have, we should stay.”

I loved that idea and started bargaining again with my baby. I prayed to God and to my baby, “If you want to be born at home, mommy needs you to have progressed past 8cm.”

I laid down to let her check me. I was almost 9cm. We were staying home.

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8pm: I started pushing, laying down in my bed, even though I didn’t really feel the urge to. Pushing laying down is literally the worst thing I’ve ever felt in my life and I cannot believe anyone has babies this way.

9pm: My contractions felt really inconsistent but I wanted to keep pushing. Pushing for that long and feeling like no progress is being made is absolute hell. At one point my midwife gave me a "focal point" of "where" to push by pressing down on my perineum. Not only did it actually feel really good, but also it helped IMMENSELY with the pushing. Highly recommend. I remember begging her, "DO THE FINGER THING AGAIN!!"

9:30pm: My husband and my friend are standing at the side of my bed, watching me push. I would push with all of my might, and nothing would happen, and it was so depressing. Then, one time I pushed, and while I personally didn’t notice anything different, my husband and my friend both GASPED at the exact same moment. They had just seen the head emerge at the very back of the canal. Watching them react was exactly what I needed. The only tragic thing was that I thought it meant I was so close to being done! Little did I know I still had an hour left of pushing.

Somewhere around this time, while pushing with all my might, my midwife reached inside and executed a “manual rotation” to try to get his head unstuck and in line with the birth canal. It was quick, and though the moment in general was chaotic, I 100% remember thinking it was the most badass thing I had ever witnessed. It was also what changed the game, and made the rest of my journey possible. I reflect on this moment a lot when thinking about how expert my birth team was, and how heartbreaking it is when “the establishment” does not take these women seriously. The brains, skills, and spirit it takes to be a midwife is very super-human, while at the same time is the essence of humanness. (If you haven’t seen my performance called “The Passion of the Midwife”, you can watch it here)

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10pm: I started squatting at the foot of my bed. This also hurt like a bitch, but it was so much easier to let go. I realized how much I hadn’t been letting go fully because I was afraid of peeing and pooping. Of course I was squatting over chuck pads, but there was still so much self-consciousness around this aspect. If you want to have a natural birth, I recommend practicing this somehow. 

Anyway, I somehow stopped caring, finally. Like, seriously stopped caring. I would grab the edge of my heavy oak-framed bed and PULL it toward me while simultaneously squatting and yelling, and fluids just starting flowing. There was blood and poop coming out, and my birth team would switch out those pads quick as lighting, and I never saw anything. But damn did it feel good! All the poop and blood meant we were close and it was the most motivating thing ever. It turns out the thing I was most scared of was actually the thing I most needed. Birth is so, so strange and beautiful.

Again, my contractions had stopped, and my team was constantly doing everything they could to get them going. My midwife said, “Your contractions stopping are a sign that you are tired,” (which made sense because I had been up for two days at that point without sleep). That scared the shit out of me. There was absolutely NO FUCKING WAY I WAS TAKING A BREAK. So, I lied, and said that they had started again. And every minute or so I said I could feel one coming out, and I’d bear down, squat, pull on the frame of my bed, and push, stand up, and repeat. It seemed like the baby wasn’t really making it any further down the canal.

10:28pm: I had just come up from squatting and bearing down. I remember my midwife said, “Ok, let’s take a little break,” or something like that. Whatever it was exactly, all I remember was yelling, “NO!!!!!!”, and with that I squatted down, and pulled on the frame of my insanely heavy bed. I remember thinking, I don’t care if I explode. I don’t care if I die, I’m not stopping pushing until this is fucking over. 

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Suddenly, I felt this burning. It’s called “The Ring of Fire”, and it’s the burning sensation felt as the mother's tissues stretch around the baby's head. (It’s very similar to sticking your fingers in your mouth to stretch your lips and pulling as wide as you can.) I yelled, “I FEEL THE BURNING THING!” To be honest, it felt really good in a really weird way, and for a SPLIT second I had a glimpse of what orgasmic birth must feel like. 

Tiffany said, “KEEP GOING!!” She was in her infamous squatting position, twisted, looking up inside of me from below. My husband was also laying on the floor on the other side, looking up, best seat in the house. (He was so cute, not afraid of absolutely anything the entire journey. The midwives even commented on how grounded and calm he was the whole time.)

The poetic thing about birth is that you have to die. Like, you get to this moment where you are SO over the pain, that you legitimately no longer care if you die pushing the baby out. You just want the pain to stop, so you push until you die. You split open, you let go of everything (literally) and you pray for death. And then BAM. In a single MOMENT the excruciating pain just...stops. It’s not gradual; it’s sudden. The pain is just over...and there...is your baby. The death becomes life.

The moment that my death turned into birth was accompanied by a *splat* that I’ll never forget. Mr. Azlan Rey Taglieber did not come out gradually, as I had seen in so many birth videos, where the baby crowns slowly, and gently just fallllllls out. Nope. Not Azzy Rey. He came out in what can only be described as a quantum moment. And just as my doula had been promising, with that splat came instantaneous relief. I remember my midwife catching him like the true professional she is and handing him up to me, bent over at the side of my bed. The next thing I remember is her yelling, “SHORT CORD, DON’T STAND UP!” So there I hunched, holding this THING in my arms, and mumbling, “It’s over. It’s fucking over. I did it. I can’t believe I fucking did it. I did it. I did it. I did it myself.”

When the cord situation was handled, they laid me on my bed and covered Azlan and I in blankets. He never cried. Not once. I remember he was lying belly down on my chest and at one point he lifted his head up and scanned the entire room, looking everyone in the eye like the freakin’ Terminator or something. It was psychedelic and wild.

The moment he was handed to me.

The moment he was handed to me.

This is me looking up at my bff and whispering, "It's over. I did it." You can STRAIGHT UP SEE those #OxytocinVibes in my eyes.

This is me looking up at my bff and whispering, "It's over. I did it." You can STRAIGHT UP SEE those #OxytocinVibes in my eyes.

The most beautiful, candid picture of my husband the moment he became a father.

The most beautiful, candid picture of my husband the moment he became a father.

Everything from there was a blur. The oxytocin rushed in, and while the midwives did their thing (which was beyond fascinating to see) I remember staring at my bff Heather at the foot of my bed, and she was crying (and snapping these amazing photos), and I kept whispering to her, “Mama, I did it. I did it. He’s here. It’s finally over. I did it.”

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They had me “birth” my placenta, which I never remember learning ANYWHERE in all my education. It’s the most wild, sensational feeling. Like birthing jello. They properly cared for it so that it could be made into placenta capsules by this amazing local doula.

Everything was so calm, and we know we were blessed to not have required any further medical procedures. The home-birth experience, when as healthy and smooth as mine, is very hands-off. There was no rush. There was no unnecessary separation. They allowed his cord to stay connected until it turned white. My midwife stitched my one, small tear in the comfort of my bedroom. We were laughing, joking, crying.

My doula fed me an ice cold cherry coke she found in the fridge (sorry, Amanda), and it was THE MOST GLORIOUS THING I HAVE EVER TASTED IN MY LIFE. I freakin’ chugged that thing. I’ll never forget that cherry coke.

The midwives told me that they couldn’t leave until I peed at least once, and that sometimes it can take a really long time and multiple tries. I remember thinking, I’m gonna rock this for you ladies. I’m going to pee quicker than anyone has ever peed as a small token for having had a 22.5 hour labor. 

AND I DID. I peed right away, and shouted, “I PEED!” And they cheered from the other room.

The next thing I know, it was probably 3 am, and Tiffany was tucking the 3 of us into bed. She kissed my head and turned out my light as she let herself out of my house. The last thing she said was, “This is your last chance to get a really long stretch of sleep.”

And that was it. I was a mother. 

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I listened to the stillness of my mostly-empty house for what felt like a really long time. Writing this now, almost a year later, I don’t actually remember if I ever slept. But I do know I didn’t leave my bed, my favorite place on Earth, and now the holy site where I gave birth, for almost 2 weeks. It was more glorious than anything I could have designed myself.

Looking back and examining the motifs that showed up in my journey, I realize that this birth for me was about letting go of what other people thought of me, and, recognizing that I can do things myself. Where many people struggle with asking for help, I think I struggle to believe I can do things on my own. I have a tendency toward codependency, often believing that I need other people to accomplish my goals (more so professionally than personally). The light side of this trait is that I have a talent for bringing teams together, and my matriarchal role is often the glue holding things together, as well as the air stoking the fire in the passions of other people’s heart. The shadow side of this trait is that I forget I’m enough on my own-- that I, too, am worthy of being produced, not just being the one who is producing. Like all codependents, I avoid looking at myself by focusing on others. Now I know that when I focus on myself, I’m capable of producing life.

Amen.”

Jessica @reverend.levity

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This is why excellent childbirth education is a must, why planning for your birth and the unexpected challenges that can arise, 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.

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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, however it unfolds!

It’s wonderful alone, a great refresher or adjunct to any other course!

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“Forget your childbirth class, and take steps to your most empowering experience. If you are thinking about conception, pregnant, or love someone who is, take it from me that her wisdom is life-changing.
Yours in the truth

— Kelly Brogan, MD

 

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.