Posterior Position: Practical Steps for Prevention and Remedy

Art by Katie Atkinson @spiritysol

A baby in a posterior position is facing your abdomen, and baby’s back is towards your back. Some babies are born easily in the posterior position with baby facing mama’s face “sunny side up.” This is especially if Mama:

• Has given birth before

• Is carrying a baby of average or smaller size

• Has an adequate sized pelvis

• Is committed, relaxed and prepared

• Is able to be upright, move and change positions at will

• Has the ability to eat and drink freely

• Is supported by providers who are patient, calm and trained to help baby turn

Art by Katie Atkinson @spiritysol

Other babies in posterior position can be more challenging, creating problems like not going into labor, water breaking prematurely before labor starts, slower more difficult labor progress, exhaustion, and labor felt mostly as back pain that can be harder to cope with. All of these factors increase the risk of complications, interventions and cesarean if baby can not be safely born vaginally. 

Epidurals increase the incidence of posterior babies, as well. But sometimes in prolonged labor, when Mama can no longer cope, the compassionate use of an epidural can help her give birth vaginally. 

The modern sedentary lifestyle of slouching in chairs over smart phones and computers, sitting back in sofas and car seats with associated poor posture, stress and tension in our bodies contributes to the rise in babies presenting in the posterior position. Many of us are no longer as active as our ancestors and indigenous cultures around the globe. We are not often leaning forward doing manual work, which helps baby’s heavier back come forward into the anterior position, unless we are doing activities like gardening.  

Art by Katie Atkinson @spiritysol

Ideally and actually most often, the baby will be in an anterior position facing your spine at term, or turns anterior during labor for childbirth. It is important to know when your baby moves into the optimal anterior position, so you can encourage the baby to stay there, which usually means an easier and shorter labor. 

You can learn on your own what position your baby is in. But if you are unsure, ask your practitioner for help figuring it out. Then try to pay attention to your baby’s position, without getting needlessly obsessed about it. This is easier to do when your baby moves or when momentarily lying on your back. It may take a lot of concentration to understand what is what at first, but soon you will get the hang of it.

When your baby is posterior, your tummy may look flatter and feel more squashy, and you may feel arms and legs and kicks all over the front towards the middle of your tummy. The area around your belly button may dip to a concave, saucer-like shape, and you may also experience long and painful practice contractions with a more severe lower backache as your baby tries to turn around to the anterior position to engage down into the pelvis.

When your baby is anterior, the back feels hard and smooth and rounded on one side of your tummy, and you will usually feel kicks under the side of your ribs. Your belly button will normally poke out and feel firm.

Pay attention to your posture and positioning at the time when your baby may be starting to descend into your pelvis, which is during the last 6 weeks of your first pregnancy, and the last 2-3 weeks of your subsequent pregnancies. The goal is to make room for your baby to assume the optimal position for birthing. 

The baby’s back is the heaviest side of its body, and will thus gravitate towards the lowest side of your abdomen. So, if your tummy is lower than your back (such as sitting on a chair leaning forward), the baby’s back will tend to swing anterior towards your tummy.

If your back is lower than your tummy (such as reclining back in an armchair with your feet up), then the baby’s back may swing towards your back into a posterior position. With this in mind, when you are 34 weeks onward, avoid any position where you are spending time leaning backwards with your knees higher than your pelvis.

Ideally, ditch the chairs. If you do need to sit on one, make sure your knees are lower than your pelvis, and your trunk is tilted slightly forward. If you need to work at a desk, consider a standing one at least some of the time, resting an alternating foot on a step stool.

Watch TV, read and lounge while kneeling on the floor, over a beanbag, birth ball, cushions, or sitting backwards on a straight backed dining room or kitchen chair facing and leaning on its back. 

Practice yoga to be in shape for the lunges and varied positions used to help your baby come down and out. Use yoga positions like bound angle (badha konasana) sitting with your back upright with soles of your feet together, or on your hands and knees while curving your back up like a cat followed by dropping your spine down in an arch and/or wiggling your hips from side to side. Get out your yoga mat and support your body with props like blankets, bolsters or blocks  as needed. 

Avoid crossing your legs, as it reduces the space in front of your pelvis and opens up the back. Sit on a wedge cushion in the car so your pelvis is tilted forward, and keep the seat back upright.

Avoid deep squatting until baby is anterior and well down in your pelvis or when needed in labor. Deep squatting opens up your pelvis and encourages the baby to move down, so refrain from it until your baby is in the anterior position. You can squat on a low stool or yoga blocks instead, keeping your spine upright.

Rest and sleep on your side, with two pillows under your bent right knee, which should be jackknifed up towards your chest, and keep your left leg straight out.

Swim with your belly downwards, doing the front crawl and breaststroke. The leg movements with the breaststroke in particular are great for opening your pelvis and encouraging your baby into an optimal anterior position.

If Your Baby Is Posterior

Continue the above mentioned positions, and add the following exercises for 20 to 30 minutes each, 3 times daily while watching something inspirational, romantic or that makes you laugh, or while listening to music:

Maintain a knee-chest position, with your buttocks sticking up in the air to tip the baby  back out of the pelvis so there is more room to turn around to the anterior position.

• Sway your hips back and forth and do the pelvic rock up and down while on your hands and knees.

• Crawl around the floor on your hands and knees, or hands and feet like an elephant.

• Scrub your floors or do some gardening.

• Swim belly down, kicking with straight legs only. Avoid frog leg movements.

• Lie on a slant board (using an ironing board or see-saw), with your head down and your legs up or lay with your pelvis and legs on the top stair landing or sofa and rest on your hands or forearms on a lower stair so you are at a similar incline. Jiggle your pelvis as you do this.

• Try resting and sleeping on your tummy using lots of pillows and cushions for support.

• Sit on a kneeler-rocker, which is a kneeling stool that sits you in an upright position with your knees lower than your chest, and has a rocker underneath for movement that encourages your baby to rotate. There are several types. See what is best for you. 

When baby turns to the anterior position, you can encourage descent further into your pelvis by walking around upright, gently massaging the baby’s buttocks downward, deep squatting and swimming, this time using lots of breaststroke frog leg kicking.

If you have lax abdominal muscles from several babies or lack of toning exercises, use a supportive maternity binder to keep baby in place. Bellefit makes a fine one, as pictured below. You can check them out and purchase here.

If Going Into Labor With a Posterior Baby

Starting in early labor, try the following movements involving altering the level of your hips, which help wiggle the baby down through your pelvis:

• Walk up and down stairs, sideways if you need to.

• Rock and dance from side to side.

• March or tread in place.

• Step on and off a step stool.

• Climb in and out of the birth pool.

• Lay on your side, so the part of your belly where your baby’s back is, can lean forward almost over the sofa or bed, with your upper knee resting on a lower chair.

• Consider having your midwives help to rotate the baby using a variety of external techniques, or if needed, by manually lifting your baby out of your pelvis during a contraction.

During the pushing stage of labor:

• Kneel on all fours, with the other leg up in a lunge. Switch legs periodically. You can do this standing, alternating one leg up on a chair moving towards and away from it. 

• Maintain a supported high squat in a birthing stool or hanging from a dangling squatting rope or your partner, with your bottom at least 18 inches off the floor.

• You can rest on your side with one leg straight out and the other leg bent up towards your chest, supported with pillows.

• Avoid lying back, semi-reclining, sitting or semi-sitting. 

For more information online, visit Spinning Babies, Association of Radical Midwives, or the GentlleBirth archives for Suboptimal Fetal Positions.

Check out my number one international best selling book Natural Birth Secrets and my Love Your Birth 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! It is now recommended by midwives, physicians, health care professionals around the globe, and doulas take it for their certification training.

As always, if you need more personalized guidance, schedule a consultation with me. 

Screening for Gestational Diabetes

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. 

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. 

Alternative Gestational Diabetes Screening Options

Do note that not all sugars are the same and they each have various effects on blood sugar. The Glucola drink is the most studied to screen for diabetes of pregnancy, and the blood test results are based on its ingestion. We are aiming to get as close to it as possible. Follow the instructions below to properly prepare for the test and increase the accuracy, avoid false positives and negatives, as well as improve your tolerance of it.

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 Start 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 consultation with me.

Check out my number one international best selling book Natural Birth Secrets now out in second edition, and in adjunct, my Love Your Birth 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!

Suffering with low back or pelvic discomfort? Having common pregnancy aches and pains and need some additional support? Try Bellefit’s prenatal support wear. I am thrilled to announce that you get a $20 Off with code: ANNE20 at checkout - if you purchase here. They also sell excellent postpartum support garments.

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 Postpartum Recovery (with a little help from Bellefit)!

For those with blood sugar issues, and diabetes, there are things you can do from making changes in your diet and exercise habits, as well as natural remedies to help!!



Postpartum Bleeding: Holistic Prevention Strategies

It is normal to have light bleeding in labor as your cervix dilates and breaks its tiny blood vessels. And as baby emerges from the birth canal there can some local tearing that can cause bleeding. Expect to experience the most bleeding at delivery and postpartum. Most of this bleeding is from where the placenta was located in your uterus. 

At normal vaginal birth and immediate postpartum, it is common to lose up to a half liter of blood. After cesarean birth, one liter of blood loss is the average. After birth, your uterus needs to contract around the major blood vessels that supplied the placenta to close them off and prevent excessive bleeding. 

The first few days, bleeding can be like a heavy period. Then, it tapers to a moderate period, after which it becomes lighter and changes color over several weeks from shades of red, then pink to brown. The body is healing the former placental site, shedding the internal scab there, and extra tissue and blood that was lining your uterus during pregnancy. 

Postpartum hemorrhage usually occurs immediately, or up to the first 24 hours post birth, and remains a major cause of maternal death in the US and around the world. It must be taken seriously. Currently, there is substantial evidence in support of what is termed ‘active management of the third stage of labor,’ to reduce the risk of severe excess postpartum bleeding. It includes the use of:

•  The synthetic hormone oxytocin (referred to as Pitocin in the US) via intravenous or intramuscular injection

• Early cord clamping with waiting 1-3 minutes until baby gets at least most of the cord blood

• Controlled traction on the cord along with counter pressure on the uterus to effect placenta delivery within the first 5-30 minutes after birth

• Uterine massage to make sure it is firmly contracted

• Assessments every 15 minutes for the first two hours. 

The above process, or a similar version, is done routinely in most hospitals, and can certainly be done in out of hospital birth settings. However, the studies that determined these procedures, were based on hospital births in mostly resource poor but also well developed countries. Like all studies, they have their limitations and flaws, some were even considered to be of poor quality according to the esteemed Cochrane Review. Also these interventions are not without side effects and concerns. The American College of Nurse-Midwives support the use of active management of third stage of labor in low resource settings, according to their position statement, although they do admit its benefits are not as clear in the low risk healthy population, and encourage the provider to have a risk benefit discussion with each pregnant family so they can make an informed decision about it. 

Most homebirth and birth center moms and providers are passionate about physiologic birthing, minimal interventions and holistic modalities, do not routinely want an injection of medication, and are more interested in natural alternatives. They trust the incredible wisdom of the normal birthing process, which has worked for thousands of years or we would not have survived as a species. They share a common belief that if it is not broken, don’t fix it, wary of medication and interventions unless absolutely necessary and benefits outweigh risks. They tend to like the alternative, ‘expectant management’ approach, which also entails close observation by the provider, but tends to take longer, allowing for the normal physiologic process to take its course, and for interventions only if needed in select cases. 

After birth, mom and baby are of course carefully assessed, but encouraged to bond skin to skin. There is no rush. Cord clamping is delayed until pulsation has ceased, or after placenta is birthed. Mom and baby are assisted to breastfeed which helps release mama’s own natural oxytocin.

The provider waits and watches for signs that the placenta is naturally separating and then assists mom into an optimal position usually using gravity, and encourages her to use her own bearing down efforts to birth her placenta. The provider may sometimes guide the birthing placenta with gentle traction on the cord, while supporting the uterus, then massages the uterus to make sure it is firm, assesses the bleeding until stable, and assesses and repairs tearing as needed. 

Certainly, if there are certain concerns or risk factors, you may truly benefit from medical prevention and active management.

If there is an actual hemorrhage, make sure your provider is skilled, experienced, and fully equipped to deal with it with at least the commonly used effective medications, IV fluids, suturing material for lacerations needing repair, and hands on care that are usually sufficient to control it successfully. 

However, you can build up a strong blood supply and reduce excess bleeding and its risks with the following suggestions for natural support both in your pregnancy and postpartum.

Prenatal Support

Make sure you get checked and treated for anemia common in pregnancy, that your iron stores (ferritin) are sufficient. 

Eat 3 large servings of wild greens or dark green leafy vegetables every day. They can be made into a salad, lightly sautéed or steamed. Good options are parsley, dandelion, alfalfa, kale, collard greens, comfrey and turnip greens.  For additional support, you can try the following:

NETTLE AND RASPBERRY TEA

Starting in the third trimester, drink 1 cup of this nourishing herbal infusion several times per day. 

1. Combine a handful each of the dried herbs Nettles and Red raspberry leaf with 1 quart boiling water.

2. Steep for at least 4 hours.

3. Strain to a glass mason canning jar.

4. You can add fresh mint leaves, lemon juice, or honey to taste.

View fullsize

GREEN DRINKS

Drink 1 ounce fresh, frozen, or powdered  wheatgrass juice 1-2 times daily to enrich and build your blood.

Or, try 1 scoop daily of powdered greens in your smoothie, 1-3 Tbsp bottled chlorophyll, or tablets or powders of spirulina and chlorella.

Postpartum

You need to rest in bed, on the couch or an outdoor lounge chair as much as possible for the first 2 weeks to recover.  Make sure you arrange for help in the home during this special time. Limiting activity and increasing rest help the area of open uterine blood vessels where the placenta detached to heal. 

Check the top of your uterus regularly for firmness, and massage it if it feels soft, until it hardens. Postpartum bleeding can be minimized when mothers are taught regular postpartum self massage of the uterus so that it stays firm and contracted around the blood vessels that supplied the placenta. 

Start breastfeeding right away, and every 1 ½ - 3 hours thereafter, especially taking advantage of the times when your baby is awake and alert and eager to suck.  Nursing frequently causes the body to secrete its own natural hormone oxytocin to keep the uterus firm and decrease bleeding.

Urinate frequently to keep the bladder empty so the uterus can contract easier.

You can also take homeopathic caulophyllum 30 or 200 C immediately after delivery, then 3-4 pellets arnica 30C under your tongue every 2-3 hours. Or, try herbal shepherd's purse, 1 dropperful of the tincture three times daily for the first 3-5 days after birth. If you need additional herbal support for heavier or persistent bleeding, you can try a dropperful of Angelica tincture a few times daily. 

Most of the supplements and herbal remedies I recommend are available on my customized online holistic apothecary. Find the best supplements that have gone through my thorough screening process there. Look in the category for postpartum bleeding prevention or search them individually. 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, and the products will be shipped directly to your home or work within a few days.

As always, if you need more personal guidance, schedule a consultation with me. 

If bleeding becomes heavier than a heavy period, and you are soaking through two maxi pads an hour for 2 hours, empty your bladder, make sure the top of your uterus is firm and massage it if soft until it becomes hard. If no relief, take 1 tsp shepherd’s purse herbal tincture under your tongue. You can repeat the dose a few times, but if the bleeding becomes heavier, contact your practitioner. 

Do read my Natural Birth Secrets book, to prepare yourself for a healthy, joyful and calm pregnancy and childbirth - NOW OUT IN SECOND EDITION!

For further inspiration, empowerment, and optimal health in pregnancy, birthing and postpartum, please make sure to take my online Love Your Birth course, so you can ROCK your journey wherever and however you plan to give birth.

Photo by Megan Hancock Photography

'Overdue' Baby: What to Do If You’re Past Your Due Date

Although it’s totally normal to have an ‘overdue’ baby, it can be very frustrating. The ideal is to prevent it early on by knowing when you conceived and getting accurate pregnancy dates.

Try to keep busy past your due date by continuing to exercise as tolerated and planning some daily pleasurable activities to keep your morale upbeat and positive.

There is a five week time frame around the estimated due date, when babies are considered term, in which it is normal and most common for moms to go into labor.

In a well-nourished, healthy woman whose pregnancy has been accurately dated, the actual time of delivery often extends 1-2 weeks past the estimated 40-week due date. This is especially true with first-time moms.

Only a small percentage of women give birth on their due date, and most babies are indeed born at the perfect time for them.

A pregnancy is actually “postdates” when it exceeds the 42nd week of gestation. In this case, it’s still best to wait for labor to occur naturally, assuming:

• Your baby is still as active as usual

• The amount of amniotic fluid is adequate

• Your baby has a normal heart rate

• The size of your baby is estimated to be compatible with the characteristics of your pelvis

• You are healthy and there are no other pregnancy complications

Monitoring a Postdate Baby

There is an increased risk of complications associated with postdate pregnancies, mostly related to an aging placenta that ceases to function as well as it did earlier, or to a baby that continues to grow to an exceptionally large size. Therefore, there will be a need to monitor you and your baby more closely after 41 weeks. Rest assured, though, that the majority of postdate babies do just fine.

FETAL MOVEMENT COUNTS

Fetal movement demonstrates adequate nourishment and oxygen from a healthy placenta. A baby will significantly decrease its movement as the condition of the placenta deteriorates. With that in mind, a wonderful way you can monitor the continued well-being of your baby throughout the third trimester is to do daily fetal movement counts. 

Pick a time when your baby is usually most active, often this is after meals, when resting or at night when lying in bed. Make sure you count at least 10 distinct moves in 2 hours. If you notice less, the baby may be sleeping. Try again a little later after drinking 2 large glasses of fruit juice, a cup of coffee and eating a complex carbohydrate and natural sugar meal, such as peanut butter and jelly sandwich on whole grain bread. Lay down after 30-40 minutes and count the number of moves. If baby is not moving after this, or you still feel that the baby is moving less than usual in a 12 hour period, contact your practitioner right away. The baby needs to be evaluated, and if in trouble, will need to be delivered as soon as possible.

IN-OFFICE TESTING

Two tests commonly done in the office to monitor the condition of the placenta and baby’s well-being are the twice weekly NST (non-stress test) and the weekly BPP (biophysical profile sonogram).

The NST uses an external electronic fetal monitor to note the character of the baby’s heart rate and its response to fetal movement. A desired response is a fetal heart rate that varies from beat to beat within the normal range, and increases at least twice when the baby moves, 15 beats per minute for at least 15 seconds within 20 minutes. Out of hospital midwives are asked and can use a fetoscope or doppler to check fetal heart rate and record accelerations manually, but it is less accurate, without a recorded tracing, not the standard of care nor evidence based; it is also not supported by modern medicine, or most of the collaborative obstetricians midwives work with.

The BPP uses ultrasound to examine the fetus and its environment in utero by assessing a variety of parameters including the baby’s movements, muscle tone, the placenta and the amount of amniotic fluid. The ultrasound can also provide estimates on the baby’s growth and weight, but they are only estimates and not always accurate at this late stage of pregnancy. Try to schedule this test during a time the baby is usually active and moving the most. On the day of the test, make sure you are drinking your usual daily 8-10 glasses of water so the baby has plenty of amniotic fluid. 30-40 minutes before the test, make sure to have 2 large glasses of fruit juice and a natural sugar/carbohydrate meal or other foods that usually wake baby up and causes lots of movement. You can even have a cup of coffee or tea just in case the baby is still sleeping after the meal. The test is somewhat dependent on the baby moving, and we would not want a false report of no fetal movement indicative of fetal stress, when the baby was just sleeping healthfully.

Natural Measures to Help Prevent Problems Related to Postdates

These recommendations are especially helpful if you had complications from postdates in prior pregnancies, you are attempting a vaginal birth after a previous cesarean, or you have other complications such as diabetes or high blood pressure and it is not advisable to let the pregnancy extend past term. Research on natural induction methods is sparse, but growing. Sometimes one remedy or a combination of them does the trick, and all is well. Sometimes, no matter what we do, we can not get labor started. Nothing works consistently, including the medications used in hospitals. Ultimately, unless there is a scheduled cesarean birth, when a baby comes into the world is ultimately not in our human control.

KNOW YOUR STATUS

If you are planning a pregnancy, keep an accurate record of your cycle and know the first day of your last menstrual period. Or better yet, the day of conception around the time of ovulation. If there is a question about your dates (if you are breastfeeding, recently miscarried, went off the birth control pill, or have long  or irregular cycles), an early first trimester ultrasound can accurately date your pregnancy. This will prevent a lot of aggravation later on, like unnecessary testing, pressure to deliver and induction based on miscalculated dates.

EAT RIGHT FOR BABY

Maintain a healthy well balanced diet including lots of:

• Organic fresh fruits and vegetables

• Whole grains

• Seeds and seed products like tahina 

• Nuts and nut butters

• Beans

• Organic tofu and tempeh  

• Organic whole eggs

• Turkey or chicken

• Beef, lamb, or wild game

• Wild Alaskan salmon 

• Organic fresh raw whole dairy-ideally goat or sheep

Use healthy fats for cooking, such as organic cold pressed extra virgin olive oil, coconut oil or goat butter. Drink at least 64 ounces of filtered, spring or well water or herbal tea per day, at least 20-30 minutes before meals. Limit intake of fruit juice and refined white flour, sugary products, and refined vegetable oils or partially hydrogenated fat. Aside from being unhealthy and fattening, the refined sugars and starches grow big babies that are harder to push out.

Make sure to eat plenty of dates and pineapples - some swear by them to encourage labor. I am not convinced, but no harm trying.

Prepare Your Mind

Prepare for a deeply positive childbirth experience. It is very important to enter labor and birth with positive feelings, trusting your body and the whole birth process.

It is helpful to write a positive birth vision, what you wish your labor and birth to be like from start to finish, and include the role and involvement of all persons who will be there.

This is something you and your partner can think about and write together. You may write as little or as much as you like, but enjoy thinking about this special time in your life. 

There are a number of methods to help you get ready for the amazing experience to come:

• Childbirth classes

• Hypnosis for birth in adjunct 

• Gentle, Prenatal and Restorative Yoga 

• Breathwork, meditation, and progressive muscle relaxation techniques (yoga nidra)

• Watching positive birth movies

• Listening to inspiring podcasts and birth summits

• Books. Some of my favorites are:

  • Mindful Birthing by Nancy Bardacke

  • Orgasmic Birth by Elizabeth Davis and Debbie Pascale Bonaro

  • Ina May’s Guide to Childbirth by Ina May Gaskin 

  • Baby Catcher by Peggy Vincent 

  • Natural Birth Secrets by me, Anne Margolis! 

Accept and express feelings that might be holding you back, such as anxiety or fear about childbirth or becoming a mother, uncertainty about your changing role as a person or relationship with loved ones, and hesitation about giving up the special attention you’ve enjoyed while being pregnant. Do not hesitate to talk with a close friend, family member, childbirth educator, or therapist, as labor and birth is heavily influenced by your emotions. Often, simply sharing and releasing ambivalent or troubling feelings does wonders to help you open up, let go and give birth. When that does not help, try releasing it from your body with breathwork.

Practice the following thoughts daily while doing slow deep breathing in a quiet meditative space: 

Spend some time saying goodbye to your pregnancy and inviting your baby to come out. Tell yourself that you and your baby are ready for labor and birth to occur. Imagine your uterus contracting. Visualize your cervix softening and opening, and picture your baby descending through the birth canal so you can cradle your beautiful newborn child in your arms. Affirm that you will surrender, let yourself be relaxed and open so that your body will do what it was perfectly designed to do - give birth to a new human being.  

HERBAL SUPPORT

Most of the supplements and herbal remedies I recommend are available on my customized online holistic apothecary. Find the best supplements that have gone through my thorough screening process there. Look in the category for labor stimulation support or search them individually. 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, and the products will be shipped directly to your home or work within a few days.

Drink fresh infused Red Raspberry leaf tea regularly. Among its many benefits, it encourages more effective uterine activity and thus an easier birth. It is optimal to make your own by adding a generous handful of the dried herb to 1 quart of water. Let it soak in a glass canning jar for approximately one hour, then strain. You can add honey, fresh mint leaves and/or lemon juice to taste and drink several times per day.

Dr. Christopher’s Birth Prep herbal formulation is designed to cause an increase in toning contractions in late pregnancy and prepare your body for labor and birth. It can be taken during the last 6 weeks of pregnancy under supervision by your provider. The recommended cycle is 1 capsule per day at week 34-36, 2 capsules per day at week 37, 2 capsules twice per day at week 38 onward, until you have your baby.

Make your own wonderful late pregnancy herbal tonic, to be used 37 weeks onward. Combine 1 dropperful each of red raspberry leaf, partridge berry, blue vervain and cramp bark with ¼ dropperful each of wild yam and motherwort in a separate tincture bottle and shake to mix well. Take 1/2 dropperful of the mixture a few times daily. You can double the dose in the last week before your due date. Other reputable herbal brands include Gaia, Wish Garden, Herb Pharm and Eclectic Institute.

You can take Evening Primrose oil capsules, 500 mg daily, as early as 36 weeks to help ripen the cervix. 

At 38 weeks gestation, start inserting 6-8 caps of Evening Primrose oil deep inside your vagina behind the cervix every 8-12 hours if:

• This is your first baby OR

• You have a history of post-term pregnancies

At 41 weeks gestation, start inserting Evening Primrose at the dose above if:

• Your cervix is still not ready for labor as measured by internal exam AND 

• Your bag of waters is intact

You should have a ripe cervix within a few days. At 41 weeks, you can also increase the oral 500 mg dose to three times daily. 

GET IN THE MOOD

As long as your bag of waters is still intact and you do not have a history of premature labor, engage in frequent sexual intercourse, especially after 36 weeks. Semen contains prostaglandins which can help ripen the cervix for labor, and reaching climax can bring on uterine contractions that may stimulate labor if the cervix is ripe and the baby is ready. The same energy that gets baby in, gets baby out, so turn up the sensual and make lots of love.

She is dancing to the music on her phone.

GET MOVING

Likewise, if you do not have a history of preterm labor, engage in regular moderate exercise like brisk walking, cycling, dancing, swimming or low impact aerobics for at least 30 minutes 5 days per week. As you get closer to term, moving around while upright uses gravity to help get the baby in an optimal position for birth, as well as press on the cervix and cause it to ripen and stimulate contractions.

As women get closer to the term, it is common to feel an increased frequency, length and intensity of Braxton Hicks contractions as the uterine muscle warms up for labor. These contractions are felt as occasional lower abdominal menstrual-like cramping in early pregnancy. But, as you get closer to term, you can actually feel your uterus ball up and harden, often from the top on downward before it softens again. They are usually brief, painless and irregular without pattern, increase with activity and resolve with rest. 

If you do not feel such uterine activity beginning at 39 weeks, you can do nipple stimulation every 10 minutes for an hour 3 times per day to stimulate contractions. To do this, roll the end of your nipple between your fingers and compress and pull slightly as a suckling baby would do. Alternately, you can, or use a breast pump, which will come in handy postpartum. 

Natural Ways to Bring on Labor

Only use the below methodologies if you have reached or passed your due date and you have discussed options with your practitioner.

Increase nipple stimulation to every five minutes for 2 hours, 4-5 times per day. It may take several hours, but with a little persistence, this can get labor going. Nipple stimulation causes release of your body’s own oxytocin, the hormone that ripens the cervix and stimulates uterine contractions. Don’t stop until labor is progressing on its own.

Take homeopathic Cimicifuga 30c, 4-5 pellets, alternating with Caulophyllum 30c, 4-5 pellets every hour for 12 hours. Repeat for two days. This gently stimulates your cervix to ripen and labor contractions to begin.

Massage your uterus with Castor oil until you get a contraction, and then repeat every 5 minutes until a labor pattern is established on its own.

If all else fails, you can try drinking Castor oil. This induces labor by stimulating your bowels, so be prepared for the possibility of diarrhea. Take 2 ounces of Castor oil in orange juice every hour for a total of 3 times. Two ounces of vodka, brandy or bourbon can be added to this mixture to loosen you up psychologically if needed. After each drink, go for a walk around your house (staying close to a bathroom!) and then take a hot shower, letting the water flow onto your nipples and persistently massage your belly with some of the Castor oil.

If still no labor, there are other things we can recommend like an enema, gently stretching your cervix open and stripping your membranes (separating the membranes from their attachment to the lower uterine wall), or as a last resort, breaking your water and/or medication if your baby needs to be born without delay.

If you need more personal guidance, schedule a consultation with me. I am happy to help!

Heartburn and Indigestion in Pregnancy

Heartburn and indigestion in pregnancy is caused by hormones slowing digestion, and the pressure on your stomach by the growing fetus. Many pregnant mamas suffer with it. Rest assured there are many holistic ways to try to prevent it, and to provide relief if it occurs. Go through the list below and see what works best for you.

Strategies for Heartburn Prevention

Eat 6 or more small meals, rather than 3 large ones each day. Eat slowly and chew everything well, ideally while sitting down, relaxed and free of internal tension. Try to remain upright or walk around and be active afterwards to aid digestion. 

Avoid wearing tight constrictive clothing, bending over forward, lying flat or going to sleep during the first 2-3 hours after eating a meal. Squat down instead of forward bending if you need to pick up something from the ground. Maintain a good straight posture when sitting or standing. 

Sleep propped up with extra pillows to slightly elevate your upper body or sleep on your left side.

Avoid foods and other substances that trigger discomfort, such as those that are: 

• Highly processed and refined

• Loaded with sugar and white flour 

• Made with refined vegetable oils and partially hydrogenated fat

• Cow's milk and milk products

• Hot or very spicy dishes

• Coffee (even decaffeinated) and other forms of caffeine

• Alcohol

• Cigarettes 

• Certain medications like aspirin and nonsteroidal anti-inflammatory drugs like ibuprofen

Eat more whole or real foods that are minimally processed, like:

• Organic fruits and vegetables

• Whole grains

• Beans

• Seeds and pureed seed products (like tehina or tahini)

• Nut butters and nuts (like raw or lightly dry roasted almonds, cashews, pecans, black walnuts, coconut, and filberts)

• Organic tofu and tempeh

• Organic turkey or chicken

• Beef, wild game, or lamb

• Fish tested free of pollutants or from non-polluted waters, like wild Alaskan salmon

• Organic eggs 

• Fresh raw whole dairy—ideally goat or sheep

• Fermented foods like kefir, sauerkraut and kimchi

Bland, pure and simple, minimally processed whole fresh foods are usually better tolerated and much better for your health. Use only healthy fat for cooking and baking, such as organic cold expeller pressed extra virgin olive oil,  coconut oil, or butter—goat is best. 

Drink at least 64 ounces of filtered, spring or well water daily between meals, at least 20-30 minutes before or 2 hours after eating. This is essential, as the water raises the gastric pH, which provides relief from the pain of the stomach acid. Add some fresh fruit like lemon, lime or oranges to taste.

Take a good all natural whole-food based prenatal vitamin and mineral supplement.

Before bed, and periodically throughout the day, take a break to disengage your consciousness from thought and routine activity in order to center and calm yourself. Unplug from your smart phone and computer. Try simply focusing your attention on your breathing, practicing meditation, progressive muscle relaxation,  yoga nidra or gentle prenatal or restorative yoga. 

Practice three part breathing by inhaling and expanding deeply to belly, then ribs, then upper chest and collar bones. Exhale in the same order with equal ratio of inhalation to exhalation, like to a count of 3:3 or 4:4. Then practice extending or doubling the length of exhale, like inhaling for a count of three, and exhaling for a count of 6.

A great box breathing exercise to do before rising in the morning, going to sleep at night, while waiting, traveling, and whenever you feel internal stress and tension is as follows:

1. Exhale slowly with an audible sigh, releasing inner tension

2. Breathe in slowly through your nose for a count of 3

3. Hold for a count of 6, while relaxing your body

4. Exhale slowly through your mouth for a count of 6

5. Hold for a count of 3, while maintaining relaxation

6. Repeat for a total of 8 cycles, or for 5-10 minutes

Another wonderful breathwork technique that should be done regularly and can be done anytime (like when you are in transit, waiting in line, on the toilet, bathing, cooking, or resting) is forced exhalation. At the end of a normal breath, try squeezing out as much air as possible, using your abdominal and intercostal muscles in your chest. Then, let the air come in deeply but automatically. Repeat for at least several minutes or as long as you would like. 

These techniques are totally safe, easy to do, health enhancing, and without side effects. See which one feels best for you in various situations and practice often so it becomes habitual. For more guidance and deeper transformation, schedule an online or in-person breathwork session with me.

When Heartburn Occurs

If heartburn occurs, some women find relief using the “flying exercise.” By sitting crossed legged or tailor style and raising and lowering your arms quickly, joining the back of your hands over your head.

Drink lots of chamomile tea, and alternate with peppermint tea and see which helps more with relieving your symptoms. You can make your own chamomile or peppermint tea in a mason glass canning jar, by steeping a tablespoon of chamomile blossoms or 7-10 whole fresh peppermint leaves in a covered cup of boiling water for 15-20 minutes. Strain, and add a dash of lemon juice and or honey to taste. 

Do also try ginger tea a few times per day. You can make your own by steeping ½-1 tsp fresh grated ginger in a cup of boiling water for 10-15 minutes. Strain and add honey to taste. 

Chew thoroughly 10-15 raw almonds then swallow.

Drink lots of pure coconut water, which is alkaline and neutralizes acid. 

Mix 1-2 Tbsp raw unpasteurized apple cider vinegar in a small glass of water, add honey to taste, sip throughout the day, and drink before meals.

Eat a grapefruit or drink a small glass of grapefruit juice after each meal.

Chew a healthy all-natural gum for ten minutes after each meal.

Squeeze the juice of 1-2 lemons in a glass of water with 1-1 ½ crushed fennel seeds. Add honey to taste. Boil as a tea or drink cool, a few cups per day. Bake fennel seeds and eat ¼ tsp of them three times per day.

Most of the supplements and herbal remedies I recommend are available on my customized online holistic apothecary. Find the best supplements that have gone through my thorough screening process there. Look in the category for heartburn and digestive support or search them individually. 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, and the products will be shipped directly to your home or work within a few days.

Try papaya enzyme chewable tablets after meals or fresh papaya fruit or juice.

You can also try slippery elm lozenges or powder, which is wonderful for relieving heartburn, as it soothes the irritated tissues of the intestinal tract. You can suck on 3-4 lozenges up to three times a day. It also comes in tea form, which you can drink as often as needed. To make your own tea, dissolve 1 tsp of the powdered herb into 1 cup boiling water or pure almond milk. If you’d like, add a dash of honey to taste.

Take 2 capsules of marshmallow root - up to four times per day. You can also make your own tea by dissolving 1 Tbsp of the powder in a cup of boiling water, then covering and steeping for 15 -20 minutes. Drink a few cups daily. 

Dandelion is also a great herb for indigestion, which can be taken in doses of one dropperful of the tincture up to 4 times daily or when you have heartburn. Reputable brands of herbal tinctures include Wish Garden, Gaia, Herb Pharm, and Eclectic Institute, or any of those in my online holistic apothecary. You can make your own herbal infusion like tea. Add approximately 5 Tbsp dried root or about 10 Tbsp fresh root to 1 quart boiling water. Let it brew for 3-4 hours, strain into a glass canning jar, and periodically sip totaling up to 2 cups per day. 

Take 1-2 plant digestive enzymes after each meal.

Another helpful remedy is Kudzu tea. To make, stir 2 tsp of kudzu root in 1/4 cup cold water for a few minutes until it dissolves. Add 1 cup boiling water. For a savory tea, add an all natural bouillon cube or to an organic miso soup broth. For a sweet tea, simply add a dash of honey.

It’s considered safe to take chewable calcium carbonate known in drug stores as Tums, but no more than 16 per day. I prefer all-natural chewable calcium carbonate. Avoid antacids with high sodium or phosphorus, such as Rolaids, Alka Seltzer and Sodium Bicarbonate, and those with aluminum or magnesium by themselves.

Activated charcoal can be taken in moderation for a severe case of heartburn, at least 90 minutes before meals and before taking your prenatal vitamins and supplements. You can take 2 tablets, and repeat only if needed and nothing else is working. Do not worry that it discolors your tongue and makes stool black, but stop if you feel side effects like nausea, vomiting, stomach pain and constipation.

Homeopathic remedies are safe and amazingly effective in treating heartburn and indigestion during pregnancy. You can consult with a classical homeopath for a remedy specific to your symptoms, or refer to books like Homeopathy For Pregnancy, Birth and Your Baby’s First Year by Miranda Castro. Common remedies include Kali Mur, Nux Vomica, or Pulsatilla. Or, try Weleeda’s Coleodorin, 7-10 drops 4 times per day as needed, and Triplex tea. Osteopathy, chiropractic care and acupuncture are also helpful especially for stubborn cases.

If the above remedies do not help, Mylanta, Maalox, or Riopan are OK if used only OCCASIONALLY and as directed. Frequent or prolonged use can cause serious electrolyte imbalances, interfere with digestion of food and the absorption of important nutrients such as iron, contribute to kidney stone formation, and actually cause the stomach to produce even more acid than before.

If you are NOT pregnant, you can take deglycyrrhizinated licorice DGL extract (slowly chew 2 tablets or take ½ tsp of powder in a little water before or between meals and before bedtime). Or, try Iberogast, an herbal combo with licorice, peppermint and other herbs proven and safe to relieve heartburn and epigastric pain.

For gas and bloating:

• Eat your foods slowly, chew thoroughly and mindfully, ideally while sitting down instead of rushing and eating on the run.

• Chew fennel seeds, drink fennel tea, or take 2-4 ml of the tincture three times per day.

• Take a high quality multi species probiotic twice daily on an empty stomach.

• Drink kefir. Learn how to make your own. 

• Take slippery elm as above. 

• Limit foods that make you gassy. Common culprits are gluten containing foods like wheat, spelt, rye, barley and some oats, some fresh fruits and veggies, cow dairy if lactose intolerant, carbonated liquids, and chewing gum.

You may need to experiment with cutting out a particular food, one category at a time, for a week or two to see if your symptoms resolve. Then reintroduce the food to see if your symptoms recur. This allows you to pin down the culprit and not eliminate numerous healthy foods without definitive proof they are making you gassy.

For those with any sort of chronic heartburn in which serious causes have been ruled out and none of the natural and allopathic remedies help, or simply if you desire more personal holistic guidance, schedule an online or in person consultation with me, or consult your local health care provider.

For more information on having the pregnancy, birth and postpartum experience of your dreams, check out my Love Your Birth Online Course.