Midwifery History and Witches

Just a taste of a much larger discussion. History for most of history was mostly ‘his story’. Through the majorly of it, women were mostly illiterate as they were not allowed to be educated like men. But until relatively recently, men would not provide care for women and their gynecological and childbearing needs even when they became physicians - as their reputations would be tarnished if they associated with women’s genitalia and their business. It was the domain of women. Women supported women.

Midwifery is mentioned as far back as biblical times, and recorded in Egypt as early as 1900 BCE. Birth was a normal part of family life, men were kept out, and certain women in each community took on the role as midwife, by following and learning from the elder midwives. They used natural remedies. Some did secretly train under physicians. In the medieval times, there are some conflicting historical accounts whether or not they were falsely accused of witchcraft and were persecuted- especially when some unsuccessful outcomes became apparent, their lack of formal training, and use of natural remedies - all a catch 22, as they were not allowed to do formal training or to practice medicine, had no access to medicines, so they used natural remedies, and were thought to go against the church, medical hierarchy and legislature which were often intertwined.

Today, thankfully there have been many beneficial changes like standardized formal education for women in the practice of midwifery, which includes sexual and reproductive health as well as equal rights of women in most developed countries. We do have a way to go in the United states and other countries, as barriers and obstacles to midwifery practice still exist. Midwifery is respected by the medical profession and encouraged for low risk population by leading health organizations. It’s now organized into a profession and supported by legislation as well as biblical religions. Hard to do the real history of midwifery justice in a blog, but at least I can reassure you I am a good witch.

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The key to a positive birth is feeling confident, strong, relaxed, and empowered during the entire process, regardless of the twists and turns it may take. I give my full heart and all I know in everything I do to support Mommas.

Upright Physiologic Vaginal Breech Birth

So grateful to Dr. David Hayes OBGYN @breechwithoutborders for their amazing continuing education workshop to thoroughly review the data and teach skills of attending vaginal physiologic breech birth globally. Some key take aways are: 📣Modern US clinicians and hospitals, and other countries that follow US, where only cesarean is taught and practiced for breech - please get back your skills and follow ongoing current impressive research and guidelines of other western countries where upright vaginal breech birth is being heavily studied and practiced as the norm, as it has been among community out-of -hospital midwives around the world through history.

More & more mamas don’t want c-section and all the risks associated with major abdominal surgery for them, their babies, and future fertility as the only option, and are seeking safe alternatives. Breech presentation occurs at term ~ 4% of the time ,vast majority are called frank with hips flexed, legs extended upward. Sometimes they can be turned head down to vertex presentation, sometimes they can’t and are breech for a reason. It’s very rare for a term baby to stand in the uterus, presenting one or two feet first - which is usually NOT footling (a common misdiagnosis) but complete or incomplete breech - hips flexed, buttocks in pelvis like a frank breech but one or two legs flexed, with one or two feet dropped down. These presentations in healthy pregnancy are fine candidates for term vaginal breech birth. It’s crucial for providers to know when to keep hands off, support mamas own movement and pushing efforts, upright positioning, how to resolve uncommon stuck arms, shoulders and head behind the pelvic bones, monitor baby’s condition, expedite birth and effectively resuscitate baby if needed.

Significantly less invasive maneuvers are required in physiological breech birth in upright positions with improved outcomes for mamas and babies. For mamas, breech birth is often claimed to be easier than birthing babies in head down position, with less injury to pelvic floor muscles and reduced tearing. Those I’ve attended all went well. The trouble and poor reputation associated with vaginal breech birth are mostly caused by unskilled providers, keeping mama on her back, impatience & pulling - which skewed the data of the older term breech trial they still quote. If you have a persistent breech baby know you have options. Get true informed consent!

If you’ve been told that your baby is breech at your mid pregnancy anatomy scan, know that baby is still swimming and it is likely they will be head down by term. If baby is breech later in the third trimester, don’t freak out. There are many ways to gently and lovingly ease your baby into vertex. Since there is slightly greater risk to breech babies born vaginally and by cesarean, and many people do not have providers near them who are skilled to attend them for a vaginal breech birth, it is ideal to try to encourage baby to turn head down.

Towards the end of pregnancy, the baby settles into its favorite position. Ideally, this position is vertex, meaning that its head is down towards your pelvis and its bottom is high up in your abdomen.

Less commonly, the baby is breech (with its head up and its bottom down towards your pelvis).

It’s not always known why a baby is breech at term. Sometimes it has to do with:

• Relationship between the shape of the baby and the shape of mom’s uterus or pelvic bones

• Location of the placenta

• Issues with the umbilical cord

• Excessive amniotic fluid

• Lax abdominal or uterine muscle tone

Labor and birth does carry more risk of complications when the baby’s head is not down towards the pelvis, even though breech is a variation of normal. So, when a baby is breech by the 30th week of pregnancy they should be encouraged to convert to the ideal vertex position. That said, the majority do turn by themselves at the beginning of the ninth month.

What to do When Baby is Breech

If your baby is breech at 30 weeks, consider doing a couple of the following exercises 10-15 minutes 2-3 times each day until your baby turns.

1. Belly massage. Massage your abdomen GENTLY in the natural direction the baby will turn. But stop if you meet any resistance, and never attempt to forcefully turn the baby yourself.

2. Visualization. Close your eyes and imagine your baby with his or her head moving down in your pelvis.

3. Coaxing. Play classical or relaxing instrumental music by your pelvis, so that the baby will turn towards the soothing sound. Or shine a flashlight by your pelvis, so that the baby may move towards the light.

4. Go for a swim. Swim laps and do some handstands in the pool.

5. Pelvic rocking. Shift your pelvis up and down and side to side while on your hands and knees.

6. Act like an elephant. Walk around the house on your hands and feet.

7. Bridges and inversions. If you have an established yoga practice, go upside down with any of the inversions, using props for supportive modifications. Headstands and downward-facing dogs work wonders.

Beginners should start with bridges. To do this, simply lie on your back with your feet flat on the floor approximately 1 ½ - 2 feet apart and your knees bent. Elevate your hips 9-12 inches higher than your shoulders. You can support yourself in bridge with a yoga block under your sacrum.

Alternatively, lie on your front in the same “upside down” position, keeping your weight on your forearms and knees wide, with your bottom in the air. Lying on three pillows or a beanbag chair can help further elevate your hips.

Or, lie bent over the edge of a sofa or top of a staircase with your legs on the floor and your body lying down the sofa or stairs. Support your body with your hands or forearms so that your torso is inclined upside down.

Gently roll your hips side to side while in any of these positions.

Taking homeopathic Pulsatilla 30C will help the above exercises be more successful. Allow 4-5 pellets to dissolve under your tongue 3 times daily for 3-5 days. As with any homeopathic remedy, avoid eating or drinking for 15-20 minutes before and after.

Natural Remedies for Breech Babies

In addition to exercises that help your baby move into the best birth position, there are a few techniques that can be administered by care providers. If you’ve tried the above suggestions without success, look for a practitioner that practices one of the following.

MOXIBUSTION

Find an Acupuncturist or Doctor of Traditional Chinese Medicine who has had success turning  breech babies to vertex with moxibustion. The technique involves burning certain herbs close to the skin at specific acupuncture points.

WEBSTER TECHNIQUE

A chiropractor trained in the Webster Technique can use this sacral adjustment to help facilitate the pelvic alignment needed for your baby to get into birth position.

MANUAL TURNING (External Cephalic Version)

If all else fails, you can opt for having your baby turned manually if the right conditions are met (such as no cord around the baby’s neck or short cord, adequate amniotic fluid, and healthy baby as detected on ultrasound with a normal fetal heart beat). Sometimes this is can be easily done in your birth practitioner’s office at 34 -36 weeks, especially in a woman who has delivered vaginally before, while carefully assessing the baby’s heartbeat. It has a high rate of success in skilled hands and supportive conditions.

Experienced midwives can turn breech babies. Most obstetricians prefer to do it in the hospital, often with medication to relax your uterus, ultrasound guidance, and continuous fetal heart monitoring. But it can safely be done out in of hospital settings while monitoring baby.

Ask for a wedge pillow to support you in a tilted pelvic lift position, or a bed that can be placed at an angle, with your legs higher than your head to help baby out of pelvis. Also, having it down while in deep meditation being supported in a pool of water has been effective and a wonderful experience.

Once the baby is turned to the head down position, stop inverting yourself, wear an abdominal binder at all times to prevent the baby from turning back to breech.

If your baby insists on being breech as you approach your due date, discuss your options with your provider. If they are not supportive of your choices for a vaginal breech birth, find a different practitioner, optimally one who has the essential skills and philosophy of birthing breech babies vaginally when appropriate and safe to do so. You can ask for recommendations at Breech Without Borders.

A baby lying in the transverse position, however, can only be delivered safely by cesarean section.

For more information on having the birth of your dreams, check out my Guide to Pregnancy, Birth and Postpartum

If you desire personal guidance, schedule an online or in person coaching call with me.

Gestational Diabetes Screen & Alternatives

Gestational diabetes is rare in the healthy population. Occurring in about 6% of pregnancies, it’s incidence is increasing largely due to the growing obesity, insulin resistance and adult onset diabetes, poor diet and lifestyle habits in the United States. There is much controversy around gestational diabetes, how it is screened for and diagnosed, and whether universal screening improves outcomes as opposed to testing when there are risk factors. If you do have it, however, treatment that includes appropriate actions like maintaining ideal weight, enhancing nutrition and exercise habits does make a significant difference in reducing the serious health consequences for both you and your baby.

In the US, it is standard of care that all women are screened for gestational diabetes at 24-28 weeks of pregnancy, although in some other European countries, only women with risk factors are screened. Screening that is most common involves giving pregnant women a “Glucola” drink that has 50 grams of sugar in the form of dextrose, and then testing blood sugar an hour later. Many holistic providers and the families they serve are concerned about this potentially toxic drink laden with chemicals that may make them feel sick, harm them and their babies, and can be associated with false positives that label them unnecessarily as high risk. This increases stress and angst, leads to more testing, monitoring and potentially other risky interventions. They want alternatives.

While it is within your right to refuse the test, you may want to consider screening for gestational diabetes in another way and discuss your concerns and options with your provider. If your provider is unwilling to work with you on this, consider switching providers to one who will. Although we do not have enough evidence that alternative screens are as accurate as using the more extensively studied Glucola drink to screen for diabetes of pregnancy, alternatives are not to be easily discounted, and may be a viable option in the low-risk healthy population. 

It is recommended according to evidence based care, but you have the right to make an informed decision to decline. The evidence does support screening for diabetes of pregnancy (GDM), as the benefits of accurate diagnosis and treatment outweigh any potential risks of the screening blood test.  Treatment does impove health and birth outcomes, whereas untreated abnormally high blood sugar levels in pregnancy carries substantial risks to mamas and babies. In the early 2000s, the US  only screened those with risk factors, but since the rates of GDM are increasing, and rarely found in those without risk factors, it has become standard to screen everyone. In the UK, only those with risk factors are advised to get the one 3 hour glucose tolerance diagnostic test. There is disagreement on the best screen to use, and what numbers are diagnostic. In the US, standard of care is to use a two step process in which the pregnant mama drinks 50 grams of a Glucola drink made of dextrose and blood is drawn 1 hour later.  Some practitioners and labs use 140 as the cutoff blood sugar level indicating a positive screen others use 135, and some use 130. The lower the cutoff number, the increased number of false positives along with a slight increased ability to diagnose true GDM, whereas the higher the cutoff number the opposite effect can result.  So it depends on the cutoff number your provider and lab uses, each showing different degrees of sensitivity and specificity. Levels of 135-140 are considered normal according to the Mayo Clinic, ADA, ACOG and other highly medical sources.

There is an option for screening for gestational diabetes by home testing. This involves checking your fasting blood sugar at home when you wake up in the morning, and then again 1 hour after eating your usual breakfast, lunch and dinner. While approved for monitoring blood sugar once diagnosed with diabetes, this method of screening is less studied and without clear standards. It is also more cumbersome and costly, as you need to get the supplies to do it, then take the time to get it right and keep records to discuss with your provider at your next prenatal visit. 

I discuss natural alternatives to the chemically laden Glucola drink in my Natural Birth Secrets book 2nd edition….but here are some basic tips if you want a more natural approach.

Alternative Gestational Diabetes Screening Options to Glucola

Starting three days before your appointment, increase complex carbohydrates such as whole grains, sweet potatoes and winter squash.

The meal before the test should only contain protein, vegetables, and unsweetened dairy. A veggie cheese omelet is a great choice! Avoid sweetened foods, fruit, and carbs. If this last meal before the test is lunch or dinner, you can eat a normal breakfast, but avoid carbs or sweets for the rest of the day.

Fresh Test is a new organic alternative that is also said to taste good, with only three ingredients. It has exactly 50-grams of glucose yet is void of unnecessary artificial additives, and is laboratory tested to be virtually equivalent to the Glucola without the unhealthy ingredients. To make your own drink that is most equivalent to Glucola without the chemical additives, dissolve 50 grams of organic dextrose in 8 ounces of water. You will need to do some math. If there are 20 grams of dextrose in 2 Tbsp for example, then you need 5 Tbsp of the powder. You ideally want dextrose, as it is the sugar made from corn that makes up the Glucola drink, and it is most bioidentical to the sugar in your blood called glucose. Therefore, it is the best alternative to screen for gestational diabetes as the standard Glucola drink does, according to the laboratory parameters designed and tested for this purpose.

Another alternative is to drink an equivalent amount of pure corn syrup dissolved in your tea, since the sugar in corn syrup is dextrose. You can find organic non GMO varieties in the health food store, but you still need to do some math, to get 50 grams of sugar total. 

Reputable research indicates that you can instead, eat 28 all natural organic jelly beans or enough that equals 50 grams of sugar, which is studied to be a reliable alternative to the 50 gram glucose beverage. It is not standardized as is the Glucola drink, amounts and types of sugars vary with each product, so you need to do the math and make sure you are eating 50 grams of sugar. The study was relatively small but results can certainly be considered.

Other less ideal options are iced tea, organic Gatorade or a cola drink that has 50 grams of sugar added in the form of added table sugar or dehydrated cane juice (sucrose) - similar to the kind of sugar in jelly beans. They are not a first choice because they are not as extensively researched, the form of sugar is different than dextrose, and thus may have a different effect on your blood sugar levels and test results, designed to screen for diabetes based on your response to dextrose. 

The blood test to screen for gestational diabetes was studied and formulated to test your reaction to ingesting 50 grams of dextrose. Sucrose is made up of 50 % glucose and 50 % fructose. You will need to read ingredients and nutrition labels to use an alternative, an important skill to develop anyway. And you still need to do some math, as the nutrition label might say something like 23 grams of sugar per 8 ounce serving. 

When going for sugars that are not dextrose extracted from corn, you can choose any sugar sweetened drink without added fruit juice. Fruit contains a different type of sugar called fructose that makes the test less accurate as it has a different effect on your blood glucose levels than does dextrose and sucrose. If you can not find or have no time to figure it out and have low risk of gestational diabetes, Snapple 16 oz raspberry peach drink is second choice. Although it is mainly sweetened with sugar (sucrose), it does have a little fruit juice, which again is mostly fructose.

Coconut water is another, but less than ideal option, as it contains sugar in the form of mostly sucrose and glucose, and it does have some fructose as in fruit. ZICO coconut water 16.9 ounces has 20 grams of sugar, so you would need to drink 2 ½ bottles. Honey is another alternative, but it is also not made up of an equivalent sugar - it is sucrose and fructose. Again, you need to read the label. Different honeys have different amounts of sugar per serving size. 

Hopefully there will be more studies on these alternatives, but for now, are listed here to consider with your provider, if for some reason you can not take the dextrose or corn syrup equivalent and you are healthy, with healthy weight and lifestyle, with low risk for diabetes. 

45 minutes before your appointment, eat the jelly beans or drink an amount that equals 50 grams total of sugar, then nothing until the blood test, which will be drawn 1 hour after you consumed the drink or candy.

If you have time, do some form of exercise like taking a brisk walk for 20-30 minutes after drinking, but before the test.

Bring a high protein, whole carbohydrate and healthy fat snack to eat after the test if needed, to keep blood sugar stable. This will help you avoid unpleasant symptoms once your blood sugar drops, like shakiness, lightheadedness, fatigue, anxiety and irritability.

Rest assured, most healthy pregnant women (about 94%) do not have gestational diabetes. A positive screen simply means you need more testing to confirm it or rule it out. And if you do have it, you can learn how to keep your blood sugar normal throughout the rest of your pregnancy and life. 

If you need more guidance,  schedule a coaching call with me.

Be informed, empowered & educated with my online course Guide to Pregnancy, Birth & Postpartum - sold separately or in a bundle.

PMS Premenstral Syndrome; A Natural Alternative Part 2

Natural Treatment for PMS

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

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

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

• Getting adequate nutrients from food, nature and supplements

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

• Empowering mindset and nurturing your spirit.

SELF-AWARENESS

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

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

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

DIET AND LIFESTYLE

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

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

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

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

Foods to limit or avoid altogether include:

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

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

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

• Alcohol, smoking, and street drugs.

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

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

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

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

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

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

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

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

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

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

SUPPLEMENTS FOR PMS

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

• Calcium, 250-500mg 2-3 times daily

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

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

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

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

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

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

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

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

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

If You Have Troubling Emotional Symptoms

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

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

BALANCING EMOTIONS

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

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

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

RELAXATION TECHNIQUES

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

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

• Avoiding overscheduling yourself

• Changing work hours to avoid rush hour traffic

• Allowing more time to get places

MINDFULNESS AND MINDSET

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

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

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

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

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

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

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

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

BREATHWORK

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

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

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

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

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

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

• Inhale in this way for a count of 4.

• Hold for a count of 4 while staying relaxed.

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

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

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

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

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

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

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

CREATE A FORTRESS OF POSITIVITY AND INSPIRATION

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

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

WHAT’S YOUR BODY TELLING YOU?

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

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

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

HERBAL SUPPORT 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

For Cramps and Low Backache 

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

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

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

In addition to the above mentioned diet and lifestyle changes:

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

• Stick to real whole organic foods

• Use and eco-friendly natural household and body products

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

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

• Limit red meat to low-fat cuts

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

Remedies to start before the cramping:

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

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

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

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

Remedies for cramps:

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

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

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

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

Use a TENS unit.

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

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

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

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

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

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

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

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

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

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

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

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

Tearing at birth

Worried about tearing at birth? If so, you are not alone. Although no guarantees (for example baby can come out with their hand by their head - compound presentation, that can result in lacerations), there are things you can do to help prevent tearing during pregnancy and at birth, even if you tore or had episiotomy previous birth. I have helped many mamas not tear or not tear enough to need stitching repair, despite the most serious of tears last time.

First off, say NO to routine episiotomy, in which the provider cuts your perineum and vagina at birth. It is is not only one of the most harmful, painful and unnecessary routine obstetric procedures, but also can lead to more serious tearing extending to the anus (third degree) and even the rectum (fourth degree). Make sure you maintain excellent nutrition, take in low glycemic foods and drink (especially if previous tear was related to baby’s large size - white four, fruit juices and sugar foods tend to grow bigger babies), avoid toxins like smoking, encourage baby anterior as you get close to term to prevent posterior positioning - I go into all this in more depth in my Natural Birth Secrets book 2nd edition. Research is conflicting about benefit of simple perineal massage to prevent tearing. What is more clear according to the research are devices specifically made to stretch vaginal and perinal muscles. In the last three to four weeks of pregnancy, you can prepare the muscles of your birth canal with one of the researched effective, pelvic floor medical training devices like Epi-no, or Aniball (easier to get in the US) as athletes and dancers stretch before working out or performing to prevent injury. They are like a balloon of sorts, that you insert into your vagina and gradually inflate 15-20 minutes daily, over a period of time to the size of baby’s head. They not only significantly reduce the risk of tearing or episiotomy, they also help you feel more prepared physically and mentally (and get a sense of what it feels like to have your birth canal stretch to the size of baby’s head so you relax into it), they ease childbirth, prevent stress urinary incontinence and been demonstrated to have other important benefits from reduced length of second stage of labor to improved Apgar scores - less fetal distress during the pushing phase. Incorporate the practice into your love making and have fun with it. Many mamas in my practice and midwives around the world swear by them, and urge first timers as well as mamas who have had more severe tearing or episiotomy previously to use them because of their successful results.

At the time of birth, to try to prevent tearing, you can honor the resting phase of labor, between end of transition and before feeling the urge to push. Wait for that powerful instinctual urge to bear down, when the baby descends low enough in your birth canal to elicit your natural fetal ejection reflex, and then use soft blowing breaths, to gently allow the emergence of your baby without forced coached pushing or pushing before you feel the urge, especially just because you are told your’e fully dilated. Gentle grunts to work with your body’s natural urges are not the problem. Avoid birthing positions like lithotomy (lying on your back with legs in stirrups, a flat surface or held wide open) or deep squatting. Use more upward, forward leaning, hand and knees or side lying, standing or dangling high squat positions, and if you are concerned, ask for perineal support by your attendants or have a water birth. I discuss this more comprehensively in my Online Guide to Childbirth.

You make plans for the best outcome, then surrender to the journey. Lean into the wondrous intensity of it all.