Should I Have an Ultrasound?

If you’re worried about ultrasound safety, good for you! You should be. The use of ultrasound in pregnancy has become almost a given. Most women in the US and Canada experience at least one ultrasound during pregnancy. Some experience several. There are certainly appropriate situations for the use of ultrasound, but a healthy pregnancy isn’t one of them.

If, after weighing the pros and cons of an ultrasound, you decide to have one, that’s entirely within your right. What’s important here is to make an informed decision rather than just exposing you and your baby to high-frequency sound waves as a matter of practice.

Is Ultrasound Necessary?

The answer to this question really differs from person-to-person and even situation-to-situation. When a health care provider recommends ultrasound to a pregnant woman, the FDA recommends that mom speaks with them to understand why the ultrasound is needed, what information will be obtained, how the information will be used, and any potential risks.

Medicine is big business. There is significant financial incentive for obstetricians to recommend ultrasounds to their patients, as they can bill many hundreds of dollars to insurance companies for each use. According to the Center for Disease Control (CDC), over-use of technology is one of the major reasons for the rise in healthcare costs.

More and more modern obstetricians have been trained to use ultrasound in place of hands-on skills to evaluate the health of the pregnancy. They use it to evaluate fetal growth and position in the third trimester, which can often be assessed by hands-on examination. They also use it to date pregnancies, which can typically be done with a little detective work.

Ultrasound is often used to determine whether a baby will be too large to be birthed naturally via the birth canal. However, ultrasound has been shown to be an inaccurate measure of birth weight. Further, our pelvic bones are joined together with ligaments that allow the pelvis to widen enough for birth to safely take place - especially when supported in upright and asymmetrical mobile positioning. This is true in almost every case, even when the mother is especially small or the baby especially large.

There are some situations in which an ultrasound is warranted. For example, bleeding in pregnancy or a serious abnormality that requires immediate or high risk hospital care. Or if mom has very irregular or absent cycles during breastfeeding, providing no real guideline for gestational age. Sometimes, if mom has a lot of anxiety about the health of her pregnancy and baby, a normal ultrasound mid pregnancy can provide some reassurance - while still not a guarantee.

The American Institute of Ultrasound in Medicine advocates for use of ultrasound solely for medical purposes, and never for things like keepsake images. And the American College of Nurse-Midwives’ position is that “Ultrasound should only be used when medically indicated.”

What Do We Know About Ultrasound Safety?

Ultrasound waves have the potential to produce biological effects on the body. They can heat bodily tissue, as well as produce small pockets of gas in bodily fluids or tissues (known as cavitation). The long-term consequences of these effects are still unknown.

Dr Sarah Buckley provides an extensive article in which she weighs ultrasound safety. In it she says,

“If there is bleeding in early pregnancy, for example, ultrasound may predict whether miscarriage is inevitable. Later in pregnancy, ultrasound can be used when a baby is not growing, or when a breech baby or twins are suspected. In these cases, the information gained from ultrasound may be very useful in decision-making for the woman and her carers. However the use of routine prenatal ultrasound (RPU) is more controversial, as this involves scanning all pregnant women in the hope of improving the outcome for some mothers and babies.”

Dr Buckley goes on to say,

“Studies on humans exposed to ultrasound have shown that possible adverse effects include premature ovulation, preterm labour or miscarriage, low birth weight, poorer condition at birth, perinatal death, dyslexia, delayed speech development, and less right-handedness.”

Despite its rampant use, there has not been sufficient testing for ultrasound safety - especially concerning routine use in healthy pregnancy. In fact, there has been very little testing at all since the 1980s even though the FDA allowed exposure limits to increase by 8 fold in 1992.

It’s important to acknowledge here that technology is often assumed safe until proven otherwise. Just a couple generations back, it was general practice to x-ray pregnant mothers. Sounds crazy now that we know more about the dangers of x-rays to the developing fetus, but back then it made perfect sense.

As Dr Kelly Brogan states, “Multiple Cochrane reviews have demonstrated a lack of perinatal mortality benefit for routine ultrasound in a normal pregnancy, and an increased risk of cesarean section with third trimester screening. A review of outcomes literature condemns ultrasound when used for dating, second trimester organ scan, biophysical profile, amniotic fluid assessment, and Doppler velocity in high and low risk pregnancies.”

While our reasons for using ultrasound are typically focused on healthy pregnancies and healthy babies, there has been virtually no proof that more ultrasounds in a population equate with better health. What’s worse is that there are concerns about their possible link to the alarming increase in autism. In addition, false positives of congenital malformations are not unusual. Sadly, this has lead to more invasive testing and abortions misunderstood to be medically necessary when there is nothing actually wrong. At the very least, this puts undue stress on momma, partner and baby.

In my opinion, technology has put distance between mommas and care providers. In situations where a midwife historically would take a literal hands-on approach to mom and baby’s health, technology now allows for a disconnect where mom is sometimes never touched by her birthing support team. My belief is that this impersonal approach can do just as much harm as the technology can.

The over-use of ultrasound also undermines a woman’s trust in her healthy body’s ability to grow and birth her healthy baby, as modern day families are putting more and more trust in technology over themselves.

Alternatives to Ultrasound

We do not fully understand the effect of directing loud sound waves at baby so frequently, but it does alter DNA in the test tube and there is strong evidence to show that any damage done is cumulative. So, if you must have an ultrasound, keep it as brief as possible and limited to as few as possible. If all is well and you know your cycles or date of conception, but you really want one, do it mid pregnancy…and of course, make sure to request a keepsake picture of your baby.

A doppler is an ultrasound device that can detect fetal heartbeat as early as 10-12 weeks, depending on the device, the location of baby, and position of mom’s uterus. It is used for each prenatal visit in many obstetrical care offices and clinics. If you want to minimize ultrasound exposure, ask for the fetoscope.

A fetoscope, which is similar to a stethoscope and works to amplify baby’s heartbeat, can be used in place of ultrasound or doppler after around 20 weeks gestational age to listen to the fetal heartbeat. It can also help assess baby’s position in later pregnancy.

When baby starts to move regularly, especially in the third trimester, I teach fetal movement awareness and kick counts. Basically, babies sleep a lot, especially when you are busy running around; but they tend to get up and become active after you eat and when your’e resting. Become aware of when and how often your baby is most active and take notice of your baby’s typical daily patterns of movement. An active baby, moving as much as usual, is a sign of fetal health and well-being. If you did not feel your baby move as much usual on a given day, eat food that has previously stimulated lots of fetal activity - usually carbohydrates like a peanut butter and jelly whole grain sandwich or cereal and nut milk - plus have two glasses of orange juice and a cup of coffee; recline in 30 - 40 minutes and count at least 10 separate kicks, body shifts, punches in the hour. Most babies will produce more than that in a few minutes, but if you are not feeling 10 separate moves in that hour, call your provider.

For most of history we did not know we were having a boy or a girl until the birth of our baby. There is something special about the surprise. But for those wanting to know the sex of their baby, blood tests are now available and are actually more accurate than ultrasound for this purpose.

Your Choice

Medical interventions like ultrasound often play into our fears and turn us away from our intuition. We have come to have less trust in the process and believe that we need to rely on technology to assure us that our babies are safe. As mommas, we have thousands of years of the birthing wisdom of our elders that we carry in our DNA. Is that less reliable than a relatively new, under-tested technology when all is well?

Midwives typically use touch and hand skills in place of technology like ultrasound. As a wholistic and integrative midwife that specializes in healthy pregnancy, I always give the option for ultrasound, and discuss the pros and cons with each family in my care. Some opt out of all unless there is an issue or complication when the benefits outweigh the potential risks of sonogram. Some do want one to confirm they have a baby in the uterus with a heart beat before it is too early to tell in the office, and a basic scan between 18 -22 weeks. For those birthing at home, some want just this mid-pregnancy ultrasound to check baby’s anatomy and that the placenta is in the right place, so they are reassured there is nothing detected that warrants birth in higher risk hospital setting.

As midwives, we do not fix what is not broken. We instill trust in the pregnancy and birth process, and have confidence in a mom’s ability to do it.

Learn more about how you can date your pregnancy,  as well as have a holistically healthy journey and birth with confidence.

Preterm Birth Story and the Little Thriving Soldier Baby

My DJ was born on Thursday, December 15, 2016. I remember like it was just yesterday. It's an experience I'll never forget. My water broke at about 6:00 on Wednesday morning. I was rushed to our local hospital, then transported to Vidant Medical Center in Greenville, NC. I was only 26 weeks, so it was reason to be alarmed. I was bedridden and given procardia to prevent the pre-term labor, but none of it worked.

7:00 am Thursday morning, the labor pains commenced. I could hardly stand it as I frantically paged the nurse. The doctor was called. She checked my cervix. It was time! The delivery was quick yet traumatic. Due to my heart condition, an emergency c-section was scheduled but my baby boy couldn't wait. With oxygen on my face and a needle in my spine, I began to push while sitting upright on the edge of the delivery table. The doctor could see his tiny head crowning and immediately laid me back, asking me to give her one more big push. As I'm pushing, I go completely numb from the spinal anesthesia but I did it! DJ was born at 10:26 am. They held him up for me to see as I cried tears of joy and worry. He wasn't crying at all but his little eyes were wide open as he looked right at me. He was so small and frail but the most beautiful angel I've ever seen. My first child at the age of 40 had arrived and I felt so blessed. After cleaning him up, they allowed me one kiss before placing his tiny body into an incubator and moving him to the neonatal intensive care unit (NICU). My parents caught a glimpse of him in the hallway and smiled with glee to meet their newest grandchild. Meanwhile, I was sent to recovery and wouldn't see my bundle of joy again for several hours.

After signing in at the front desk of the NICU, washing our hands (of course), my then husband wheeled me to Pod B where our beloved was waiting. There he was all swaddled up with his sweet little face covered due to the ventilator needed to help him breath. He weighed only 790 grams (1 lb, 12 oz) and 13 inches long, but strong! As I watched our son fighting for his life, I cried and cried. Why did this happen?

I greatly assume it was my gestational diabetes or the stress I was under due to a trying later failed marriage. However, I read that there are risk factors for being born early, such as infection, placental problems or genetic problems, but in many cases the cause is unknown. An estimated 15 million babies are born too early every year, That is more than 1 in 10 babies. Wow! I couldn't imagine the arduous journey ahead for my peanut. All the tests, diagnoses, procedures, bradycardias and near fatal incidences that caused such an emotional rollercoaster. Without God, he wouldn't have made it through, and I wouldn't have made it through my postpartum period that was thankfully short-lived. DJ spent four months and one week at James and Connie Maynard Children's Hospital, and I never left his side. I was there every single day for him, enduring the worse and the better times. Thank God for the tremendous support of so many in our corner, including the awesome hospital staff and The Ronald McDonald House of Eastern NC. 

After leaving the hospital, I became a stay-at-home mom taking care of DJ full-time because he was considered disabled and unable to enroll into daycare. I'm so blessed to be here for every waking moment, watching my son continuing to thrive despite his near fatal illnesses and hospitalizations.  I was also blessed with the time to be able to self-publish my first children's book entitled, "The Mighty 1", dedicated to my baby. DJ is now two years strong, weighing 24.5 lbs and 32 inches long. My little soldier is so amazing and I'm beyond blessed to be his mommy. 

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The Mighty 1 is a poetic tale about a brave soul who is tiny but mighty, just like the miracle baby in your life. Every year, millions of babies are born prematurely and many will spend several weeks or months in the neonatal intensive care unit. It's such an emotional journey for families whose lives have changed in an instant. This book was created to bring inspiration and smiles to all of you. It makes a great read for NICU cuddle time, and the perfect keepsake too! Preview and order your copy of "The Mighty 1" now.

By Ebony Moore @ebonydmoore

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 profound natural healing modality called Clarity Breathwork. Helping people heal from birth trauma and other traumatic experiences, emotional pain and inner stress is one of my passions and areas of expertise. I also devoted several sections of my Natural Birth Secrets book on birth trauma in both moms and babies, and also wrote a book called the Trauma Release Formula…both are available on Amazon.

Preparing for Pregnancy

There are so many things to consider when preparing for pregnancy

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

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

Eating for a Healthy Pregnancy

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

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

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

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

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

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

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

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

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

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

Preparing for Pregnancy with Supplements

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

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

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

• A multivitamin/mineral combination

• Methylated folate in B complex

• Calcium, magnesium, and D complex

• Omega three fatty acids

• Herbal iron depending on your iron stores

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

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

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

Exercise for a Healthy Pregnancy and Beyond

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

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

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

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

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

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

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

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

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

Tapping into Mindfulness and Joy

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

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

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

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

Fertility Awareness

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

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

Dancing With Special Needs

“On Six Years of Freyja-hood

Freyja turns six tomorrow. 

Today was a rainy day of mini-vacation on Cape Cod. There were Mad Libs, there were board games, there was reading, there was the telling of stories. As she got in the bath tonight, I told her the story of her birth and she rolled her eyes and groaned and said "But I already know, Mama!"

Considering the complexity of this child, it's a pretty simple story (featured in more detail on the blog). I will leave out the drama for the squeamish readers and summarize here: Early one morning, spouse says: I'm cancelling my plans for tonight. I feel like I should stay home just in case. Remembering the way my first birth went, I say, no, go ahead and keep your plans! This baby has another two weeks to go. Have a nice day! And off I go to work and about five hours later I go into labor at my desk. Since the last baby took five days of labor to make up her mind about coming out, I think nothing of the contractions and reassure people that everything's fine and there's no cause for alarm. Then I lose my mucus plug while interviewing a candidate for a position on my team (whom I immediately hire), think I am bleeding to death, go get an emergency ultrasound, am told that I am definitely in labor and that I should under no circumstances go back to the office or go anywhere but straight home. In the cab, I alternate between not wanting to scare the cabbie into thinking I will give birth in the backseat of his car and expressing extreme gratitude that my spouse's spidey sense was dead on. He was home to receive me. Figuring we have a long night ahead of us, I sit on the birthing ball, bouncing and screaming and watching a season and a half of Breaking Bad, try to take a nap as Ina May Gaskin advises, and then lie in the bathtub for so long that I don't realize I am transitioning until I am puking all over myself. Spouse calls midwife when my screams become continuous but for the retching. Midwife shows up in a flash and says "holy shit you're having this baby right here in the bathtub, right now" and seventeen minutes later it's 5:03 am and I have a baby on me and a plate full of Oreos that I cram into my mouth two at a time because my blood sugar is low and giving birth makes me hungry in the kind of way that only a gigantic bag of double-stuf Oreos and a newborn baby can satisfy.  Midwife and doula clean up and clear out, other child wakes up, spouse passes out from exhaustion and I don't sleep well for the next five and a half years. The end. 

So six years ago I was having the homebirth I always wanted, giving birth to a second daughter, completing my family and perfecting my life. 

Five years ago I knew there was something terribly wrong with my baby and was trying desperately to convince everyone else that she needed evaluation and help.

Four years ago I was drowning in diagnoses and medical information, trying to navigate the Early Intervention system in New York City, knowing that if she lived, we would leave. If we stayed, she wouldn't stand a chance. 

Three years ago she was placed in the wrong classroom. I knew it on the first day of school and it took the DOE an entire year to move her. So much precious time wasted. (But she rocked a ballet dance recital! It was covered in the NY times!) .

Two years ago we made the decision to leave our hometown, the Big Apple, where were were both born and raised and where we'd always been sure we would also die. We knew it was the right thing to do to give both of our children what we felt they needed and deserved.

One year ago I felt hope as she started her last year of preschool in a truly integrated, inclusive setting.

And here we are today, getting ready to celebrate her birthday. It's a celebration of life. Her life. Of beating the odds, a day at a time. For the older she gets, the more victorious we feel. Her diagnosis is cruel and unforgiving, but she doesn't know it. It doesn't stop her and she doesn't let anything stop us. We are sleeping a little better now because we mostly believe she will be alive when we go upstairs to rouse her every morning. She is thriving and blossoming and she is just so busy being.

She has big plans for her birthday. She has a fancy dress to wear and wants cake and donuts and presents and family and friends. She tells everyone she sees that she is turning six on September 24th and that she is really excited. But her party is a week later, so she plans to celebrate all week long. And then it will be Halloween soon and she's going to be Princess Anna, who is from Frozen, in case you didn't know. She rattles this all off to the checkout person at the grocery store, the barista at the coffee shop, the bus driver, the lady who cleans the bathrooms in the town center. And they look down at her and I watch them take her in, their eyes running over the walker, the leg braces, and the sparkly eyes and big smile. I see her as they see her and I watch as they fall in love with her and I am proud that she is mine, this little being who spreads joy wherever she goes, warming the hearts of everyone she encounters.   

In a way, Freyja is Milo, the main character in my favorite book of all time, The Phantom Tollbooth. Milo is sent on a journey, the truth of which the King of Dictionopolis and the Mathemagician both know but refuse to tell him until he has returned successful. Instead they wish him well, set him up with an entourage consisting of bugs and dogs to keep him safe, give him tools to fight the demons he will surely encounter, and send him on his way. 

Remember that thing we told you we couldn't tell you until you were back? the kings say to Milo at the festival they hold in his honor upon his return, having rescued the princesses of Sweet Rhyme and Pure Reason and restored them to ruling the kingdom of Wisdom. Yes, he says eagerly. What was it? "It was impossible," one of them says, very seriously. "Completely impossible," says the other.

If Freyja is Milo, then I am the King of Dictionopolis, powerless to fix the plight of my own child but with a head full of all the letters and words in the whole world, and Johnny is the Mathemagician, with a magic staff that rewrites all the formulas and creates solutions to unusual problems. We created this child. We unwittingly set her up for this journey, and now, just shy of six years in, we can look at her and marvel. What we knew would be completely impossible, she has done. 

But I'm never going to tell her that. 

At Back to School night a couple weeks ago, several parents came up to me, introduced themselves, and told me they hear about Freyja every single day from their kids. I smiled and made small talk and chatted about play dates that probably won't ever happen, and I wondered how they knew I was her mother. How did they know? I had no name tag on. I hadn't even opened my mouth. Do I just exude L'Air Du Special Needs Mama somehow? 

I pondered this as I sat down in her tiny chair. We listened to her teacher as she talked about school rules, field trips they needed volunteer chaperones for, allergies in the classroom, ziploc bags full of extra underwear and socks I needed to send in. In seventeen little folders on the tables were seventeen green sheets of paper, upon which we were asked to write down some emergency contact information. Under this was a blank space, at the beginning of which read: "Tell us a little bit about what your hopes and dreams are for your child to achieve this year!" I chewed my pen cap, thinking. I peered over at the mom next to me to peek at what she was writing, but I couldn't see. I wondered what other parents said. I want Junior to be able to read chapter books this year. We hope that Molly continues to benefit from the socialization that preschool provided last year. Who knows? I closed my eyes for a moment and then I wrote: "Freyja is a hardworking, determined child who benefits from an inclusive environment with neurotypical peers as models. Of course we are concerned about her academics but even more important to us is this: We know that schoool, like life, is full of joys and frustrations. We want Freyja to be able to face both as she grows. She will never stop working toward her goals. If she knows you are working with her, she will never ever let you down, so please don't ever give up on her." And I folded the green sheet of paper and dropped it into the pile on the teacher's desk and walked out into the night, back toward home, to my sleeping girls, to the life that I never knew was possible until Freyja came along. “ by Aimee Christian @thewriteaimee

Raising children is the biggest blessing and can be incredibly challenging, let alone parenting a child with illness or special needs. My own wake up call was my daughter’s serious disease, and then my sister’s son who was diagnosed with having autism. I had to hit rock bottom several times before I woke up. But I am so glad I woke up, so I could be there for myself, my family, my friends and my clients.

Are you overstressed? Do you suffer from psychic pain? Do you battles symptoms from previous traumas (physical or emotional) which are interfering with your present life, and preventing you from living fully and in your joy? If you need help healing, and want to release what is no longer serving you and get yourself back…. I have a program specifically for you, that includes this revolutionary and powerfully effective natural healing modality called Clarity Breathwork.  Helping women heal trauma, inner stress and emotional pain is one of my huge passions and areas of expertise. Because I have been there, because I have healed myself, because I am so grateful I took the additional training, because I care and feel compelled to share this gold with others. Pain is common, suffering is rampant…but suffering is a choice, as are peace and joy. I must do what I can help people find their peace and joy that is our birthright as human beings!

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.