What’s the Deal with Amniotic Fluid

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Amni-what now?

Amniotic fluid is the liquid that is within the amnion or the membrane that holds the baby.  Also known as waters.  So when you hear the term her water broke, that is amniotic fluids.  It serves as a cushioning to protect baby from external movements for shock absorbtion.  This fluid also does a lot more.  It also a source of nutrients, water, and biochemicals from mom to baby.  As the baby grows, the fluid allows free movement allowing baby to do those acrobatic acts they like to do in utero.  This helps their muscles and bones to develop.  Also, when baby swallows this assists in the baby’s gastrointestinal development.  It also helps keep baby’s body temperature just right.

 

What’s it made of?

It’s made mostly of water and electrolytes early in pregnancy.  Later on it also contains, proteins, carbs, lipids, phospholipids, and urea.  These “ingredients” help your baby in its development.  So your body is making baby Gatorade of sorts.  Plus it that’s where the baby’s urine comes from along with meconium (black sticky first poo after birth).  Yes there is pee in there.  It’s totally fine.  How much is in there? Well, it increases with the growth of baby.  It peaks at about 800 ml and decreases to 400 ml by week 42.

Where does it all come from?

It comes from moms plasma and later in the pregnancy baby contributes by urinating.  This is why staying hydrated is key in pregnancy.  You should drink at least 8 cups a day.  You have an increase blood volume and are producing amniotic fluid.  By the time of the birth you will have about 1 liter of water gushing out.  Little known fact, the majority of births don’t see the waters break until baby is actually emerging.  It is not as common to have a giant gush of waters and then baby.  It happens, just not as often as people (the media) thinks it does.

Did you know that amniotic fluid can tell us a story.  It is used to test for diseases and genetic anomalies.  The amount excess or shortage can signal problems with baby or signal maternal issues.  In labor, the color will signal whether baby has had a bowel movement which may or may not signal fetal distress.

To Break or Not to Break

Breaking of the water as mentioned before can be spontaneous in active labor or at the birth of baby.  Sometimes a labor has gone on for a while with no “progress” and the provider may suggest rupturing your membranes.  They may use a amnihook or amnicot.  The amniohook kind of looks like a crochet hook.  It is inserted and used to break the waters.  The finger cot is the same except its a little finger cot with a bit of a hook on it.  It does not hurt and mom may feel relief at the breaking of the waters.  Some providers feel that this potentially will speed up progress.  There is no real proof it actually does.  It can potentially make it harder to cope with the labor pains since now instead of a cushion of water on the cervix, the baby’s head is not directly on the cervix, leading to the need for pain medication.  It can be helpful if labor has been long and the provider wants to make sure there is no meconium is in the fluids.  All in all though, it seems like it’s best to leave things alone if possible.

So that is it.  That is a brief run down on amniotic fluids.  Have a fun fact you’d like to share please comment.  Did your water break before the baby came, leak during labor, or gush right at baby’s arrival?

Anemia + Pregnancy

Anemia

 

By Deidre M. Medina, LMT, CBE

What is anemia?

There are a few kinds of anemia in pregnancy.

Pregnancy-related anemia when your blood has too few red blood cells which in this kind of anemia is due to the increased blood volume during pregnancy.

Iron deficiency is due to mother not having enough red blood cells stores to match the babies use of the mother’s red blood cells for its growth and development.  This is the most common type of anemia in pregnancy.

B-12 deficiency is when there is a low level of B-12 which is important for making red blood cells and protein.  If you are a vegan mom, you may find yourself with this type.  It is found in eggs, milk, poultry, meat.

Folate deficiency can inhibit the production of red blood cells.  It is a B vitamin that is water soluble.  Folic acid is the synthetic version of folate and is not as easily digestible and folate.  You can find folate in dark leafy green vegetables, beets, Brewer’s yeast, liver, etc.  It is a common deficiency because the modern diet of processed foods, though supplemented with folic acid, it is not easily usable as the folate found in fresh unprocessed foods.  Your baby needs this to prevent birth defects of the brain and spinal cord.

Using Food as Medicine

Nutrition is most important in pregnancy.  Food can be used to prevent deficiency and to balance any deficiency in mild cases. If you are in need of iron-rich foods, then you can look to dark leafy greens, beets, legumes, beans, kelp, meats, poultry, liver and more.  For iron to be absorbed well, vitamin C rich food should be paired together or supplementing with vitamin C.   Cooking in an iron skillet helps increase the iron in your meal.  A favorite plant based supplement for iron that I took for all three of my pregnancies was Floradix (I am not affiliated with them) or if you are gluten sensitive their Floravital.  It is an herbal iron supplement that is non-constipating.

There are foods and supplements that can inhibit the absorption of food.  The use of antacids or other alkalis will diminish iron absorption.  These are sometimes commonly used in pregnancy if you are affected by heartburn.  Coffee and black tea can inhibit absorption as well.  Calcium can inhibit iron absorption so it is important to try avoid taking a calcium supplement at the time of iron supplement or with your iron-rich meal.  Iron absorption is a slow process and takes about 2-4 hours for the body to absorb iron so you could take iron supplement at separate meal time than your calcium.

Folate-rich foods that can boost your folate spinach, kale, beet greens, beets, chart, organ meats, brewer’s yeast.  Bean sprouts of mung bean, lentils, and soy are really good sources of folate.  B-12 can be supplemented with a sublingual B-12 or shots every three months during pregnancy.

Eat Well, Be Well

So the pattern as you can seen for a well-nourished pregnancy is eat to well-balanced meals.  Make sure your meals are mostly fresh whole ingredients.  Eat less processed foods.  It really pays to understand nutrition and how it affects your pregnancy and your baby’s health.  Learn, have fun with it, ask for help.  Eat well, be well.

Sources:  https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=90&ContentID=P02428  Staying Healthy with Nutrition by Elson M. Haas, M.D.

Water Birth – Is it for you?

 

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Preparing For Your Water Birth

It can’t be denied that when in labor water can become your best friend.  It is common to be in and out of the shower or tub and sometimes, not even wanting to get out of the water.  This speaks volumes about the benefits of water in the birthing tool kit.   This is especially true in the instance of water birth.  Birth in the water?  Why would I want to birth in the water?  Is that safe?  How does one go about having a water birth?

 

What’s So Great About Water Birth?

 

According to Water Birth International the benefits of a water birth are:

 

  • Water facilitates mobility and enables the mother to assume any position that is comfortable for labor and birth

  • Speeds up labor

  • Reduces blood pressure

  • Gives mother feelings of control

  • Provides significant pain relief

  • Promotes relaxation

  • Conserves mother’s energy

  • Reduces the need for drugs and interventions

  • Gives mother a private protected space

  • Reduces perineal trauma and eliminates episiotomies

  • Reduces cesarean section rates

  • Is highly rated by mothers – typically stating they would consider giving birth in water again; some even stating they would never give birth any other way!

  • Is highly rated by experienced providers

  • Encourages an easier birth for mother and a gentler welcome for baby

 

Movement is so important in labor and laboring in water can help you to move freely into any position you feel is comfortable.  That gives us another benefit.  You move into what position is comfortable for you, not what is convenient for the care provider.  Water birth can give you a sense of control. With regards to speeding up labor, Michele Odent a pioneer of water birth in the 1980’s in France, found that women whose labors were not progressing beyond 5 cm, quickly dilated once immersed.  He attributes this to the reduction in catecholamines, which have been associated to slowed or stalled labor, due to pain relief from water immersion.  Michele Odent felt that when these levels go down it allows a release of oxytocin and cervical dilation.  The reason for reduced pain in labor with water immersion may be because the warm water causes peripheral vasodilation and improved blood flow which provides pain relief. Penny Simkin (1989) attributed the pain relief to “ cutaneous nerve endings causing vasodilation in the skin, relaxation of tiny muscles in the hair follicles and generally a reversal of the sympathetic nervous system response flight or fight response.”  As a massage therapist, I’ve seen this to be true in my work with nurturing massage.  

 

So many benefits to water birth.  There needs to be more research to give water birth more credit.  Many of these are observed findings by countless physicians and midwives.  Though there is no formal bodies of scientific research there is a plethora of observational evidence in the safety and benefits of water birth.  According to Evidence Based Birth’s website over 20,000 water births have been documented in some manner.  So if you are having or have had a water birth consider sending your experience into Water Birth International’s Registry.  They have been building a database since 2004.  Well now that we’ve talked about benefits let’s look at safety.

 

Is Water Birth Really Safe?

 

One of the first concern you  may have about water birth is, what if the baby breathes in.  Well, let’s get a little technical on how amazing our bodies are.  When the baby is in utero, the baby makes a breathing movement intermittently, about 40% of the time.  The baby does not breath as such in utero.  It’s more of practicing since baby’s lungs are filled with fluid that keeps the lungs protected and open to get ready for the real breathing work.  This fluid’s presence will keep any other fluids from entering due to its viscosity.  Also, there is low blood supply to the lungs and this causes high pressure in the lungs making it difficult for any other fluid to enter.  When the time nears for labor to begin, prostaglandin E2 levels released from the placenta increase which slows or ceases fetal breathing movements.  As the baby is being born, the levels of prostaglandin E2 remain high and this keeps the lungs from functioning which is the first inhibitory response.  Another mechanism in place to help the baby is baby’s are born with low oxygen levels, which causes an absence of breathing, and thus the baby’s first reflex is to first swallow not breath.  There are other physiologic mechanisms in place that would keep the baby safe during a water birth.  There is a more thorough paper on this that I highly recommend parents to read regarding the safety of water birth at Evidence Based Birth.

 

When Is It Not Advisable?

 

The following are a few contraindications to birthing in the water:

 

  • Amnionitis

  • Maternal fever greater than 100° F or suspected maternal infection

  • Active genital herpes

  • Fetal distress

  • Rupture of membranes greater than 24 hours

  • Thick meconium-stained amniotic fluid

  • Excessive vaginal bleeding

 

 

Setting Up For Your Water Birth

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So you have decided a water birth is definitely for you.  So how do you do this?  Well the first thing is look at your space that your birthing in.  If you are in a birthing center, the setup is already designed just right.  If you are birthing in home, you want to have a birth pool set up within a hose distant of a faucet.  Be sure that your faucet is compatible with the adapters for the hose.  You want to make sure there is enough space all around the pool for the support team to access you or your partner.  Once you’ve found the right space, you’ll need to choose the right birth pool.  Considerations are the size of your space or if your partner is going to be getting in the water with you will you both fit.  Most pools are spacious enough for two.  There are many sources to buy or rent a pool.  Yourwaterbirth.com has many supplies for water birth and homebirth and you may find that your midwife or doula has an account and recommended supply list.  Ask them and if they do they will be able to give you a 10% discount.  If you would rather not purchase a pool many midwives or doulas offer birth pools for rent along with the needed supplies to go along with the pool.

 

It takes about 20 minutes to inflate your pool and it is a good idea to inflate it before the big day to make sure there are no tears causing leak in the pool.  Something you don’t want to find out while you’re laboring.  It’s also good to practice different positions in the pool ahead of time before it is filled with water to see all the possibilities.  The next important thing is to make sure that the pool’s temperature stays between 92-100 ° F (32-38° C) but not exceed 101° F (38° C).  We don’t want your core temperature to increase because that can adversely affect the baby.  You can find a thermometer that floats in the pool to keep track of  your pool’s temperature.  It’s important to keep the water comfortable and keep it warm.  With that said, being in the warm water, make sure you stay hydrated and use a cool cloth on your forehead or neck.  

 

How deep should you fill your tub? You should fill the tub at least 20 “ of water depth to give benefits of buoyancy and to insure the baby is born into the water and not exposed to the air too early so as not to stimulate inhalation.  You don’t want it so deep so that the care provider is not able to see what is going on either.  It takes about an hour to fill the pool up and when things start moving along you can fill it about half way, so that if it cools a bit you have more space to fill it up with more warm water.  Keep it covered in between when you get in and out to lengthen your pools warmth.  Someone should stay with you at all times.  You can get in and out whenever you feel you need it.  It has been observed that it may be best to wait for immersion once your 4-5 cm dilated and have a well-established pattern.  Really though whatever helps you be comfortable and helps you manage the contractions do it.  You want to alternate between water and land to maintain the effects of the water.  Dr. Michele Odent’s research found that when entering the water early in labor (before 5cm dilated),  a surge of oxytocin happens and this increases uterine contractions and helps cervical dilation and effacement move along.  This effect, however, decrease if immersed 90-120 minutes.  So if you do get into the pool in early labor, take breaks so that labor can consistently progress.

 

Birthing In The Water

Finally you’re ready to push and as baby is born, your care provider will make sure to gently but quickly bring baby to the surface.  You finally feel the warm and slippery little person that has been a part of you for the last 9 months.  Eyes so bright looking right at you.  What an unforgettable moment.  If you are comfortable in the water and all is well, you can birth the placenta in the water.  Just have a lightweight bowl on standby to place the placenta in.  You’ve done it!  With any birth choices, do your research.  Watch water birth experiences.  There are plenty on YouTube.  Or ask your childbirth educator or doula their suggestions for water birth videos and resources as well.   I hope this article has been helpful.  Happy birthing!

 

My favorite resources:

Books

Websites

 

 

 

Tend Your Garden Well

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I love this quote from Ina May Gaskin. It is a subject that can be missed in the prenatal care. But as the quote says you need a nutrient rich soil to grow healthy plants. Why should this be less important when it comes to nutrition and babies.  What do you know about nutrition?  What are your nutritional needs in pregnancy?

Nutritional Needs of Pregnant Woman

With the growth of baby your stomach has been pushed up further and not much room for a big meal. This means that every bite counts. Eating small meals throughout the day instead of three larger meals.

Non-pregnant vs. Pregnant

Calories
1500-2000 to 2300-3200

Fiber
8-15 g to 10-15 g

Protein
45-65 g to 75-90 g.

Calcium

Your needs are greater in the second half. Insufficient calcium will lead to your body pulling it from your bones to nourish the growing fetus. Baby’s teeth, bones are forming and calcium helps with muscle and heart function, blood clotting and nerve transmission. Sources of calcium include milk, yogurts, cheese, if vegan then make sure you take in extra soy products and nuts and dark leafy greens.

850-1200 mg. to 1200-1600 mg.

Iron

You need 30 mg to 60 mg of iron when pregnant. Iron builds blood cells in mother and fetus. Anemia is when your blood has a lower than normal number of red blood cells. Anemia also can occur if your red blood cells don’t contain enough hemoglobin. Hemoglobin is an iron-rich protein that gives blood its red color. This protein helps red blood cells carry oxygen from the lungs to the rest of the body. If you have anemia, your body doesn’t get enough oxygen-rich blood. As a result, you may feel tired or weak. You also may have other symptoms, such as shortness of breath, dizziness, or headaches.

Because iron is not absorbed efficiently, more is needed to make it more available. So most women are usually prescribed an iron supplement. Not all can tolerate this. The supplement I recommend that is non-constipating and won’t make you nauseous is Floradix (a plant-based iron supplement) (I am not affiliated with).  It can actually help with constipation.

Nutrient-rich foods to prevent deficiencies:
Eggs
Fish
Poultry
Organ meats (organically raised; these foods are really more like medicines)
Milk products
Red meats
Nuts and seeds
Whole grains
Wheat germ
Yeast
Molasses
Seaweeds
Leafy green vegetables
Other nourishing choices to consider is the use of herbs. The #1 choice for nourishing women’s health in general and especially in pregnancy is red raspberry leaf tea. This has been shown to tonify the uterus and it is said if drunk daily in pregnancy will assure a healthy labor. Stinging nettles is another great choice. You can make a tea with this or use it as a green in soups. This is high in vitamins A, C, K, calcium, potassium and iron. Stinging nettle is used in many pregnancy teas (and women’s health teas in general) because it is a great all-around pregnancy tonic. Rosehips are another great choice because it is high in vitamin C which is key for absorbing iron well

Fiber

Fiber is important because the digestive system slows down. So to avoid or relieve constipation drink plenty of water besides milk and herbal teas and eat high-fiber foods like whole grains(Ezekiel 4:9 bread) (not affiliated with this brand), fruits, and vegetables.

Morning Sickness 
Another challenge to staying nourished in your pregnancy is morning sickness.  Though it’s name implies it only occurs in the morning, this can last throughout the days. If you find you can’t keep down water or food then speak with your care provider immediately because you could be dealing with hyperemesis gravidarum (HG)       Hyperemesis gravidarum is a more serious condition that will require the care of a physician.  Morning sickness is actually helped with good nutrition choices.  Vitamin B6, C, E and extra magnesium and potassium can lessen or relieve morning sickness.  Red raspberry, peach leaf, tea, peppermint, and ginger root teas can help with nausea.  Avoid fatty foods, junk food, and obviously  alcohol. Upon awakening eating dry toast and crackers has been shown to stave off nausea. Snacking on carbs or protein throughout the day.

Nourishing yourself with the goal of giving  baby the best start is possible. It’s a delicious and fun adventure when you explore your choices armed with nutritional knowledge. If your still unsure seek out the assistance of a nutritionist  knowledgeable in the needs of pregnant women. Speak to your care provider or midwife. Your friendly neighborhood doula (hi there) will have some insights as well. If unsure ASK!  We are all to eager to help you have the best pregnancy you can.  I hope you have a happy and nourished pregnancy.  Have suggestions for eating well in pregnancy?  Please share in the comments.

Third trimester blues

        Here I am with baby three one year ago.  I am 9 months +1 and will be meeting my little guy 2 days later.  If you’re approaching the end of your pregnancy you might find this familiar.
9 months and 1 day pregnant!
9 months and 1 day pregnant!
      So, is the baby here yet?  Ugh! Here we go again.  Lets face it, when you get close to the end of your pregnancy, things are getting, lets say difficult.  You may feel tired all the time.  You dread dropping something for fear of having to actually maneuver to retrieve it.  You are always in the bathroom to pee, but forget about going poo.  You eat, you get heartburn.  You eat a little and get full, starving thirty minutes later.  Walking is good for you but man does your feet, and/or back hurt.  Then you hear those, lets call it what it is, obnoxious questions.
      Oh, the baby isn’t here yet?  (Insert sarcastic reply)
      How big is the baby now, he/she looks big?  {Insert rude comeback question, in your head of course or better yet out loud)
      Are you carrying twins?  {Use the “are you serious” facial expression of choice here}
      Hang in there girl!
      Sleep.
      Eat well and as best you can.
      Move your body how you want as often as you can.
      Did I mention sleep!
      Last, but not least, those annoying comments, don’t even dignify them.  You are beautiful, you are not too big or too small, your baby is going to come when she is ready.  Keep you head and feet up and enjoy your beautiful pregnant you!!