RhoGam Shot in Pregnancy

Risks and Benefits of RhoGAM

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

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

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

What is the Rh factor?

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

What is Rh incompatibility and sensitization?

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

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

How can Rh problems affect the fetus during subsequent pregnancies?  

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

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

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

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

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

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

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

Can you tell if the baby is Rh-positive?

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

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

What is RhoGAM?

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

 
What are the benefits of RhoGAM?

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

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

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

When is RhoGAM recommended, and why?

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

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

Is there controversy around RhoGAM?

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

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

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

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

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

What are the risks of RhoGAM?

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

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

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

So, is the RhoGAM shot absolutely necessary during pregnancy? 

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

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

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

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

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

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

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

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

Birth Story of Redemption

“Redemption: Koen James

Stalking your Instagram and drooling over all things Birth!

I wanted to share my story:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

@shelbylclowers’’ 

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

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

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

How To Build A Successful Midwifery Practice

What I Didn't Learn In Midwifery School

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

HBAC Birth Story - Homebirth After Cesarean

“Having a HBAC was really so special after a totally unnecessary c-section with my first. I’d love to spread the word that it’s possible. So many people think it’s not.

And Then There Were Four

The last time I typed up a birth story it wasn't one I was super excited to share with the world. I'm eager to get this one down before I forget it since labor amnesia sets in quick and because this one could not be more different than the last. A friend of mine who also had a particularly difficult first labor said that when she had a second child she wanted a do-over. At the time I was telling myself that all that matters is getting a healthy baby and while I still believe that, I am very happy that things went the way I wanted them to this time. 

[ I am not sure I need to but I would like to stop here and warn any readers that since this is a blog entry about giving birth, there is some TMI. ]

Last Friday I was 39 weeks. It started like any other day since I became full-term, with me thinking "Will this baby come today?" followed immediately by "Nah, I have tons of time left" followed by a much quieter "...maybe."  

Because Thora's birth was such a mess and because I believe it was the four days in a row of acupuncture that my midwife sent me for before my due date that started my prodromal labor and not Thora herself, ready to be born, I was treating this time like it was my first time. Lots of people said that since Thora was born four days before my due date, this one would be early too, but I was telling myself just in case that I really didn't know when Thora would have come, had circumstances been different. This one could very well wait until long after my due date. I knew four or five other people who were all due around the same time as me and I kept saying they'd all be first, just so I wouldn't be disappointed if I went on to 41 or 42 weeks. 

So on Friday morning I didn't think anything of going to work like usual.  I had a lot to do, including dealing with three chickens I was fostering in my tiny shared work space. (Don't ask!)

Johnny, on the other hand, seemed to know something was up. The night before I'd had what I thought could be a little leaking of amniotic fluid. (Any expecting parent has to be familiar with the awful "here, smell this, is this pee?" ridiculousness) Even though he didn't say so, he was on high alert. That morning he drove me to work so Thora could see the chickens, and en route he announced that he was cancelling the plans he had with his friend for that night just in case the baby came. I told him not to be silly and encouraged him to go ahead because my due date was still a week away and who knew when he'd get to go out again. Likely that leak was nothing. But he insisted. 

At the office, I managed to knock out a few things before everyone else arrived. I did an interview and wrote up a document I really needed to get out. I exchanged emails and calls with a few people. All the while I was having contractions and they were pretty regular but mild so I didn't say anything to anyone, just kept working and waited for them to pass. Around 1 pm when we were discussing lunch options, I felt a sudden gush and ran to the bathroom. Knowing that only 8% of labors start with the water breaking, I wasn't exactly sure what I'd find but I did not expect to see a lot of bright red blood. A lot. I had also passed a clot the size of my pinky. It didn't look like a mucus plug, it looked like a blood clot. And sitting there, I passed another. So I completely panicked. I called my midwife who seemed calm but mildly concerned. A few minutes later she called back: she'd been able to get me an emergency appointment at the women's ultrasound office I'd been going to, which was up on Madison Ave about a fifteen minute walk away. She encouraged me to put on a pad so I could see how much I was bleeding and said I should call her from the doctor's office to let her know what was going on. I called Johnny, who wasted no time getting into the car and on his way.

I threw my stuff into a bag and fled. As I waited impatiently for the elevator, a coworker and mom of three passed me in the hall. She took one look at my face, nodded and said "Oh yeah," in a knowing voice. "Good luck!" In my mind I was thinking "But I'm not in labor!" though I wasn't about to stop to explain.

Of course it was pouring rain so finding a cab was virtually impossible. Frustrated, I called Johnny again and reminded him that my first labor was during a blizzard and complained that it wasn't fair that this happens to us during horrible weather. Someone from my office accompanied me to the corner of First Ave with a big umbrella, trying to help me flag down occupied cab after occupied cab. There were a handful of other people doing the same and I ran in front of them, totally focusing all of my fear into anger at them for not seeing me standing there and giving me the first cab that pulled up.

Meanwhile Johnny and Thora were stuck in traffic on the FDR drive on their way to meet me at the ultrasound place. In the cab, my contractions slowed and my bleeding too. I could still feel the baby moving so I knew she was alive, but bright red blood is never a good sign in pregnancy so I was still very worried. I raced into the office and told them who I was. The woman at reception reminded me that I didn't have an appointment, that they were fully booked but would see me when they could. I reminded her as sweetly as I could that I was 39 weeks pregnant and bleeding a lot. Then I sat down to wait. My name was called not two minutes later and Johnny and Thora arrived about two minutes after that. The ultrasound showed that the baby and her heartbeat were fine, there was a lot of amniotic fluid, the placenta was intact, and everything was overall peachy. Both the doctor there and my midwife on the phone said they could not easily explain the blood, that they guessed it was either my mucus plug or a small placental abruption. My midwife ordered me to go right home. "Do NOT go back to work," she said sternly. How did she know what I was thinking?! She insisted I rest and check in with her in another hour or so. Feeling calmer, I apologized to the receptionist on our way out. She looked relieved. I thanked everyone for seeing me so quickly and we headed back out into the rain.

We did go right home. My contractions continued, mildly. Johnny and Thora took a walk to Uptown Juice Bar, our neighborhood veggie restaurant, to pick up some dinner, while I tried to nap. By 5 pm or so we were timing the contractions but they seemed pretty stable at 5 minutes apart and lasting only 30 - 45 seconds. After Thora's birth, which was a full five days of contractions like that and two hospital visits during which I was checked and promptly sent home, I was determined not to be the boy who cried wolf a second time, so I kept telling the midwife it was no big deal, that I wasn't concerned yet.

We got Thora to bed around 7 and settled in front of the TV for some Netflix streaming. I texted my sister to tell her I thought I was in labor. Then I sat on the birth ball and moaned and yelled my way through three episodes of Breaking Bad before Johnny told me that the contractions were obviously getting longer and more intense. I was still in denial because they weren't any closer together. I called our midwife again around 10 - a full 45 minutes later than she'd asked me to, she reminded me. I had a contraction as we talked and I tried my best to talk through it. I did not want her to have to come all the way here only to tell me I was having prodromal labor and then go back home. She said she was ready to go whenever we said the word, but I told her we were still fine. 

Oh the stupid things that go through a laboring woman's head. At this point I was thinking "What would a woman birthing with Ina May Gaskin do now?" I tried to channel the birth stories I'd read over and over in Spiritual Midwifery. These women would have made food, cleaned their RVs, worked in their garden, gone for a hike, hugged a tree, or gone to sleep. Remembering that with Thora I gave up pushing for a c-section because I was too tired to keep going after five days of being too excited about having a baby to rest at all, I picked sleep. I took a quarter of a Bendaryl and lay down. I knew that if this was really it, the contractions would not slow. But they did, to about 8 minutes apart.

I did manage to doze a little between contractions but they kept waking us both up and after an hour or two, they got more and more intense. By 2 am they were 2 - 3 minutes apart, lasting 90 seconds to 2 minutes. I was nauseous and restless and knew sleep was now out of the question. Benadryl or no, I was wide awake and in agony. Soon I was in pain even between contractions and I was suddenly throwing up and having to poop and everything else all at once. This was it. 

Johnny called Joan while I ran the bathtub. She'd been asleep but was instantly alert. The no-nonsense woman she is, she declared me to be in active labor and said she was on her way. Still not wanting to be humiliated for thinking I was in active labor when I wasn't, I was nervous that the bath might slow things down by the time she arrived. But it didn't. 

Between contractions in the water, I was fine. I sat there in the candlelit darkness and tried to relax. I could talk, even joke around a little. The contractions were painful as hell but in between them there was a minute of reprieve. Also they felt very different from the ones I had with Thora. Thora was posterior (meaning she was face up) and the resulting back labor was agonizing in a whole different way. At the same time, this was pain like nothing I ever knew. 

Joan and her assistant S. arrived around 2:45. Joan checked me right away. 7 centimeters. She said "The rest could either be slow or fast but I'm thinking fast" and went back to making her preparations. There was no time, she said, to set up the birth pool. I was going to have the baby in the bathtub.

They started setting things up while Johnny sat with me and made sure I had water, Emergen-C, whatever I would drink. S, Joan's assistant, held my hand ("but only if it's not annoying," she reminded me) and helped me keep my sounds low and my shoulders low and relaxed. The pain got more and more intense and I got louder and louder. I surprised myself by how much I was screaming and howling and growling but it was what I had to do. Joan shrugged. "Some people just need to roar their babies out," was all she said. This kept on. I beat my hands on the lip of the tub with every contraction and screamed this guttural, totally insane scream. I was sitting cross legged, sort of like in lotus position, in the center of the tub, leaning over the middle of it. My head was resting on a towel they put on the lip of the tub and my hands were hanging over the side so I could remember to keep them unclenched. Rayna, my cat, was sitting right beneath my hands keeping a close watch on things. Johnny sat on the closed toilet seat and S sat on the floor next to Rayna. Joan left me to it for the most part, but came back in periodically to tell me I was doing great. I panted and screamed and shrieked and didn't believe her. "I don't think I can do this!" I heard myself whine. "You ARE doing it," everyone chanted, in unison, in response.

Then all of a sudden everything changes. My growl gets deeper and I hear myself scream like I never, ever have before. It gives me chills to think about it now. "That sounds like pushing!" calls Joan from outside the bathroom. She is suddenly there, checking me, asking if I feel like I need to bear down. "I don't know what I feel," I say. I am hoarse and my mouth is dry and I'm starting to whine again. "I feel her in my butt now and it really, really huuurrrtttss."  Yep, she says, that's pushing. And then I am at my absolute least attractive, retching and vomiting and panting and feeling like I'm crapping my brains out and watching the water around me get redder and redder. I'm babbling like a fool, asking how soon I can get an IUD, asking if I am going to make it through this, begging for it to stop. My head is filled with wild images: I'm thinking of my birth mother who should be there with me but isn't, of long-haired hippies who don't feel any pain as they push, of how I am certainly waking our daughter, asleep in the next room, of how I am definitely terrifying our neighbors and scaring my husband from ever wanting to look at me naked again, of being split open, of living through this to meet my baby.

Joan is suddenly all business. She kneels down and makes me change position. "If you are going to have this baby here, you need to stretch out and lie down on your right side and hold up your leg like this." She holds up my left leg like this. She gives Johnny the job of holding it up even further and pushing it back against the wall of the tub. She lets out some of the disgusting water and runs more warm water in the tub and over me, saying now it's too cold for having a baby. 

And then I am gone. What takes over is this primal thing, barely human, screaming and roaring. From a million miles away, I hear "I can see her!" and "She went back in, but that's okay, she's stretching you so you don't tear" and I'm panting and and my voice is saying "I can't" and then I'm wailing again and there are hands on me that I push away and suddenly I feel a pop and I hear "That's the head!" One more howl and a huge push that takes everything out of me and the next thing I know she's crying in my arms and there's a warm blanket and a towel being draped over her and I am spent but I have my baby and I did it, just like the women in the hippie books and exactly how I always wanted, with my husband next to me and my daughter asleep in her room just ten feet away and we are all in our element in our home and I can't believe it. It is 5:33 am on Saturday, September 24. I have been in labor for over seventeen hours and I have pushed for only 23 minutes.

Freyja Rae is teeny. She is coughing and sputtering. I count fingers and toes, look at her tiny face, pick some vernix out of her ears. I push out the placenta and then a few minutes later, I manage to cut the cord myself because Johnny doesn't want to, snipping Joan's finger in the process. I smile and apologize. She shrugs and says she's been cut worse. I ask her if this ever gets old for her and she says with a smile, "Nope. Never." Everything is quiet. Then at some point, I ask how in the world women go through this pain. Her answer is simple. "We can do it because it ends. No matter how long it lasts, it always ends." 

Freyja and I lie there together for a few minutes in the gross bathwater while I think that over. We are happy and exhausted and I'm thinking about Rocky calling to Adrian that he did it. Johnny snaps a few pictures and S snaps a few more.

Then Joan wraps her in another warm and dry receiving blanket and hands her to her father, saying she's not ready to nurse yet but that she needs skin on skin contact with Daddy, and then I am fading away and I'm gone. 

I smell ammonia and hear someone say "smelling salts." My blood pressure is so low they can't even get a reading, but the smelling salts are so awful they wake me up enough so I can turn my head away. This feeling is nothing new for me. I have low blood pressure all the time so when I am sick or weakened I always react by getting dizzy and feeling faint. I am not concerned, but Joan and S are. A peanut butter sandwich appears before me and a glass of some flavor of Emergen-C that I didn't pick out is shoved in my face and a straw stuck in my mouth. I want to be in bed, with the AC on, wrapped in a blanket snuggling with my new baby but I know I can't make it there so I take slow bites and sips and wait.

Gradually I regain strength. We drain the tub and I am able to stand long enough to rinse off in the shower while they make a bed out of a plastic tablecloth and wee wee pads, right there on the tiles. I lie down and as I do, I hear Thora, awake. Freyja is passed back to me and I latch her on for the first time while Johnny brings Thora right to us in the bathroom. She's not fully awake and is very unsure of what's going on. "Mama?" she asks dubiously.

I sit up and nurse cross legged on the bathroom floor while they set up a spot for me in the living room. Moments later, Freyja and I make our way over to the couch. S hovers and makes me eat and sip sweet tea while I nurse Freyja. Johnny is next to me cuddling Thora, who asks for a pinky. A blissful moment: I am with my family.

But I am tired. Joan examines Freyja and prepares to weigh her like a bunch of bananas. "Any guesses?" We venture a few, but we are all off. She is much smaller than her sister was, only 6 pounds and 12 ounces. 19 inches long. Head and chest circumference are both 33 inches. "She's symmetrical!" Joan laughs. Freyja is perfect. And since we are at home, nothing invasive happens. She hasn't been suctioned. There is no ointment in her eyes. Joan doesn't even clean her off. Instead she rubs what's left of the vernix into her skin and wipes her down with some olive oil. She grabs a onesie from the pile, a white one with a pink and black skull and crossbones, a gift to Thora from our friend Missy Church. I smile and say she's dressing her like a punk rocker. "For you, nothing less!" she smiles back.

Johnny gets up to dress Thora. I help her on with her shoes and give her a big hug and kiss. Johnny brings her downstairs to our neighbor to hang out with her two girls for the morning and I throw on a shirt and get into bed with my new daughter. Joan hugs me and tucks me in. I hear Johnny come back in and he joins me a moment later, closing the bedroom door behind him. We hear cleanup noises in the rest of the apartment, and a few minutes later, the front door opening and quietly closing, as we three drift off to sleep.

I did it!”

Mama @thewriteaimee

Photo credit to @db4johnny (my spouse)

---

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

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

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

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)!

Postpartum Struggles Are Real

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Statistics show that about 15% of new mommas experience postpartum depression. And 70-80% of us experience “baby blues,” that 2 week period after the baby’s born when we can feel confused, overwhelmed, sensitive and just not ourselves.

If this is you, you’re obviously not alone. Here’s what you need to know: There is no failure in pregnancy, birth and postpartum.

You can move with grace through potential sadness, grief, fear, and anger to embrace and heal from your experience. When you are struggling with feeling overwhelmed and exhausted, depressed or anxious, unconfident and unsure, a holistic postpartum plan can give you back your joy and confidence. You got this. But it takes a village to raise a baby and new parents. Sometimes we just need a little guidance and support - especially in modern times.

I know what it’s like to experience birth trauma and struggle to put it behind me. Or to try to find balance when there’s a new baby in the house - when the idea of “me time” seems like a cruel joke.

After My Own Last Birth I was Sick and Alone

Even as a nurse-midwife, I found myself in a postpartum situation that confused and scared me.

Several weeks after the baby was born, I began to feel like I was over caffeinated. My thoughts were racing, I was extremely agitated, panicked, completely overwhelmed and unable to function. Making decisions felt impossible and I couldn’t sleep. I felt faint, and was losing weight.

I was ashamed and embarrassed. How could I, an expert, find myself in such a state of confusion and intolerable symptoms of anxiety? I didn’t want to ask for help. The people I did ask were unable to treat me, and my husband was confused and worried.

I started to have scary and repetitive thoughts. Noises seemed too loud. Faces seemed too big. What the hell was wrong with me?! I felt like I was drugged. Somehow I suspected my thyroid was off, so I asked my colleague to draw my labs. Then I nearly passed out.

After a call to 911 and subsequent visits to a postpartum stress center, I learned that I had postpartum thyroiditis, an autoimmune condition in which the thyroid initially makes too much hormone, before not making enough.

The diagnosis gave me the confidence to finally accept help. I knew now that I wasn’t crazy. I knew I shouldn’t be embarrassed...but I was at the time. I stayed with my mother, who lived several hours away - near the center - for an entire month. And my husband and friends all worked together to care for my other kids at home.

I had to stop work for an entire year while recovering from my illness. And it took me a number of years to fully heal using a comprehensive holistic approach. My yoga and meditation practice were life changing, but the complete healing happened after intensive Clarity Breathwork sessions. It was the most delicious and miraculous feeling of relief I ever experienced.

The Forgotten Fourth Trimester

Throughout history, children were raised in communities. When a woman labored, she was surrounded by friends and family. She was attended to by the community midwife, often the same person who was there for the births of all the other babies in the area and potentially even her own birth. After birth, she was off duty to rest, recover, and get the breastfeeding, while her tribe cooked, cleaned, took care of the other kids, and did needed errands.

Now, we live separated from our families, often experience pregnancy through postpartum more or less alone, and deliver our babies amongst strangers. A sister or mother-in-law might stay with us briefly after our babies are born, but then we’re on our own.

In the US, women are sent home alone after a few days in the hospital, and maternity leave is shockingly brief. We’re expected to pick up at work right where we left off after just a few short weeks at home with our new baby. Paternity leave is almost non-existent in this country, except for some more progressive family friendly workplaces.

Of course so many of us experience depression, anxiety, worry, and a lack of confidence! This way of viewing motherhood is simply unnatural. You can’t institutionalize the sacred.

But, thriving postpartum is possible. Especially when you go into it with a plan.

How to thrive postpartum

If you’re currently struggling in your “fourth trimester,” here are some tips you can implement right away to take the edge off.

Exercise. Try to make time for whatever type of movement feels good to you. Have someone take the baby while you go to a class. Put her in the stroller and go for a walk. Put on a workout video while she’s napping. Turn on some music that reflects your mood and move your emotions with your body; then turn on something upbeat and dance like noone is watching.

Connect with your community. Join a mommy support group either online or in-person. Reach out to friends and family that tend to cheer you up or make you feel comforted. Ask a neighbor to join you for a walk. Take a postpartum mommy and me yoga class. Don’t be afraid to open up about how you’re feeling. You might be surprised how many people can relate. And make sure to get daily soul nurturing hugs.

Meditate. Taking time to center down can make a big difference in our energy and confidence. Spend quiet time in nature. If you’re not accustomed to meditation, find a guided audio to listen to or just turn on some relaxing instrumental music, get comfortable and focus on your breath.

Nap. Now is not the time to stress about housework. Sleep deprivation leads to depression, anxiety, reduced memory and concentration, weight gain and a host of other health problems. Allow yourself to nap when the baby’s napping. The housework can wait.

Skip the sugar. Regularly eating sweets and simple carbs like breads and pastries puts us through a vicious cycle. Sugar crashes lead to low energy and low moods, which lead to carb cravings. Stick to fresh whole foods - and add more protein and healthy fat for a balanced diet and a balanced mood.

Do what you love. Each day, do things that bring you joy - even if it is for a few minutes at first. Think about what excites you and try to do more of it in your regular routine. Let it be easy and simple. That may be a quiet cup of tea, a visit with your friend, a stroll in the park, a flower or herbal bath in candlelight, watching comedy, getting a massage, doing some yoga. As baby gets older, make taking some time to yourself each day to do these things a non-negotiable like eating, drinking and sleeping.

Seek help. When your sadness or anxiety feels like more than “baby blues,” seek a qualified professional to help you through it. If, like me, you have an undiagnosed medical condition, the suggestions above just won’t be enough.

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)!

“Anne Margolis was my incredible midwife. She is practical, science-based, and vastly experienced, but most importantly, she’s an awakened woman here to light the path to your most joyful self. Anne is the incredible midwife who taught me, through this process, how to midwife my own patients’ rebirth experience.
Her own educational course is a deep but manageable dive into her accumulated wisdom, packaged for your journey. Forget your childbirth class, and take steps to your most empowering experience. If you are thinking about conception, pregnant, or love someone who is, take it from me that her wisdom is life-changing.Yours in the truth.”

— Dr. Kelly Brogan MD

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