I’m finishing up this post sitting outside at sunset because the weather is finally cooling off in Virginia! Hallelujah!
My husband told me the other day that my personality shines in the fall and winter – is that the opposite of hibernation? Either way, I am loving the cooler temperatures and looking forward to sweater weather and 40 degree days.
On instagram, I’ve been posting tips for mamas and midwives since the beginning of the year. Most of these are the bread and butter that I talk about over and over with mamas in the clinic or get messages from friends about. A lot of the tips are simple, but make a big difference in your pregnancy.
Check out the tips below and stay tuned for some more! Love the tips? Make sure you’re signed up for the monthly newsletter (or sign up at the bottom of the blog page or in the linktree on instagram).
And….I’m working on a novel education course for pregnancy behind the scenes. Here’s my questions for you guys:
If you could wave a magic wand and ask for anything in your pregnancy care – what would you ask for/would have asked for to make it better?
More education? Different provider types? Better childbirth classes? More time with the provider? Longer visits? More explanations about why things were done or not done?
I’m looking for a couple of mamas to chat to see what would have made your pregnancy care better. I’m offering either a set of free digital templates for your pregnancy care or a $20 starbucks card in return for about 20 minutes of your time! If you’re interested, email me a firstname.lastname@example.org or send me a DM on insta. If you know a mama who would be great to interview, share this post with her!
Tip #1: Sit down and make goals to bolster YOU mama!
It’s so important to set goals for yourself – but goals don’t have to be big! Maybe it’s a daily 20 minute walk? Whether you’re pregnant or thinking about becoming pregnant, read a book on the pregnancy or postpartum periods (good books to start wiht are: Ina May’s Guide to Pregnancy, Mindful Birthing, The Fourth Trimester and Babies Are Not Pizzas)? Even something simple like taking a daily multivitamin or your vitamin D. Take time to think – what one little thing could I do each day that would make me stronger for pregnancy at the end of 2022? If you’re thinking about becoming pregnant in the next year, this is a great time to instill habits that will help you stay healthy and strong while you are trying to become pregnant.
Tip #2: Find yourself a midwife!
Why should you consider a midwife? A retrospective cohort study titled “Comparison of Midwifery and Obstetric Care in Low-Risk Hospital Births” published in Obstetrics (2019) found that when compared to OB/GYNs, midwives:
- Had lower rates of interventions (interventions assessed in the study included: induction of labor; artificial rupture of membranes; epidural use; episiotomy; and physiologic birth – defined as spontaneous labor, no artificial rupture of membranes, no oxytocin, no epidural, and a spontaneous vaginal birth with no episiotomy)
- A 30% lower C/S rate in nulliparous women (first time mamas)
- A 40% lower C/S rate in multiparous women and lower rates of operative delivery (use of vacuum or forceps to assist birth) in both nulliparous and multiparous women.
There are a few different types of midwives (CMs, CNMs, and CPMs). Most midwives work in the hospital setting, but many midwives offer services at the home or birth center. CMs and CNMs also offer gynecologic care (well woman visits, pap smears, vaginal infections…) – so look for a midwife outside of pregnancy, birth or postpartum for your routine well woman care.
- This chart offers information about the different types of midwives: Read the chart here (ACNM).
- Find your midwife here: https://www.midwife.org/find-a-midwife
Tip #3: Make sure you are taking a prenatal vitamin with 18 milligrams of IRON!
Iron is an essential element needed in pregnancy for you and your baby. Iron is a key component of the red blood cells in your body that help carry oxygen to the other cells. You even pass iron to the baby so that the baby can make their own red blood cells too! Prenatal gummies do not have iron in them. I spend a lot of time talking to patients about this. If you like the prenatal chewable idea, try an over the counter kids flinstone vitamin instead! They are easy to take and you can continue to take them as long as you are breastfeeding. Wondering what else you can do to prevent anemia in pregnancy? Check out these foods that are high in iron – print out a list and post it on your fridge: Iron Rich Foods
Tip #4: Find a doula!
Doulas are trained to support women and families during pregnancy, birth and postpartum periods. During labor and birth, doulas provide continuous emotional and physical support and coordinate interventions for pain (position changes, breathing, relaxation, comfort measures), while simultaneously encouraging informed consent each step of labor. Doula care has been associated with shortened labors, reduced need for pain medication, reduced need for pitocin, fewer operative births or cesarean sections and higher satisfaction with labor (DONA, 2012). Find a doula at www.dona.org/
Tip #5: Make exercise a habit in your pregnancy.
Did you know that regular exercise in pregnancy is associated with a higher incidence of vaginal delivery and a lower incidence of too much weight gain, diabetes in pregnancy, high blood pressure in pregnancy, cesarean section, preterm birth and low birth weight (ACOG, 2020). Women that regularly exercise report fewer body aches and lower back or sciatica pain. Exercise has not been associated with an increased risk of preterm birth and regular exercise can improve postpartum recovery time after your birth (ACOG, 2020). Not sure where to start? Start with a 20 minute walk every day and work up from there!
Tip #6: Plan for a safe and satisfying birth!
Try these tips from Grow Midwives:
1. Read evidence-based books. Not sure where to start? These are some great reads for pregnancy:
*Babies Are Not Pizzas: They’re Born, Not Delivered! by Rebecca Dekker
*Birth Matters by Ina May Gaskin
*Creating Your Birth Plan: The Definitive Guide to a Safe and Empowering Birth by Marsden Wagner
*Ina May’s Guide to Childbirth by Ina May Gaskin
*Mindful Birthing: Training the Mind, Body, and Heart for Childbirth and Beyond by Nancy Bardacke
*Natural Hospital Birth by Cynthia Gabriel
*The Birth Partner: A Complete Guide to Childbirth for Dads, Doulas and All Other Labor Companions by Penny Simkin
*The Official Lamaze Guide: For a Healthy Pregnancy & Birth by Judith Lothian
2. Use your consumer voice! Look for a provider that willingly shares C/S or induction rates and is highly recommended.
3. Expect hospital transparency. (I love this one! Look up your hospital cesarean rates and reviews on google).
4. Learn about the different providers that can help birth your baby (CNM, CPM, CM, OB/GYN, family practice MD/DO…there are many!).
5. Engage in your care. Read your healthcare records. Know your medical complications and the plan for each during pregnancy. Understand why labs and ultrasounds are being done during your pregnancy. And ask questions or voice concerns every the step of the way!
6. Know that birth should be a SAFE and SATISFYING thing!
Tip #7: Ask for the golden hour after birth.
The Golden Hour is the first hour after the baby is born. There are things you can do right after your baby is born to improve bonding, help your baby regulate temperature, and reduce stress levels in the baby and you:
*Delayed cord clamping
*Placing the infant on the mother’s direct skin after birth for at least one hour
*Completing baby assessments while skin to skin (i.e. listen to the heart rate and respiratory rate of the baby, checking the baby’s tone, checking the baby’s temperature) – nurses can even give the baby his/her first medications while they are skin to skin 🙂
*Delaying other interventions until later (bathing, weighing the baby)
Plan for these simple but IMPACTFUL things in your birth!
FYI: The World Health Organization recommends delayed cord clamping for 1-3 minutes. ACOG recommends delayed cord clamping for 1 minute.
Neczypor, J., & Holley, S. (2017). Providing evidence-based care during the golden hour. Nursing for Women’s Health, 21(6), 462-472. doi: 10.1016/j.nwh.2017.10.011
Tip #8: Sleep better in pregnancy.
Wonder what causes issues with sleep during pregnancy? The list is long: frequent urination at night time (this is because your kidneys filter more blood when you are lying down), leg cramps, heartburn, baby movements, contractions, snoring, racing thoughts or anxiety about pregnancy, labor or birth, contractions, or just being uncomfortable from the pregnancy. Try these tips for better rest:
*Sleep on your sides. Left or right side – it doesn’t matter. Your back will thank you. (Sleeping on your stomach is okay too if it doesn’t bother you.)
*Use pillows for support. Pregnancy pillows are great, but you don’t need one. Try a pillow under your belly and one under your lower back. You’ll fill like the middle of the sandwich, but your body will sigh with relief.
*Try a warm-hot bath with Epsom salts as a soak prior to bed. Make sure you use 2 cups of your favorite Epsom salt in the bath for full effect. The salts will help with swelling, restless legs, back pain and general muscle soreness. And the relaxation will help you sleep. Repeat every night or as often as desired for maximum effect. And yes, scented salts are okay to use.
*Prevent heartburn. Avoid foods that cause heartburn. Try not to lay down within 1 hour after eating. Take a medication for heartburn (TUMS or OTC).
*Try mindfulness or meditation prior to bed. Cat cow poses are great for stretching out the entire spine before crawling in to bed.
*Try a sound machine (dohm machines are a favorite at our household); you may end up using one for the baby too. Use black out curtains. Stop using screens in the bedroom.
*Ensure you are working out, stretching and staying active. Your body changes so much throughout the pregnancy. One of the best ways to sleep well is to ensure you continue to use your muscles throughout pregnancy.
Tip #9: Make sure your prenatal has everything that is recommended!
Do you know why a prenatal vitamin is recommended in pregnancy and during preconception? Two main reasons: folic acid reduces the risk of neural tube defects and iron reduces the incidence of iron deficiency anemia. Lots of women don’t like to take their prenatal early in pregnancy because they can actually cause more nausea if the pill is a larger size or they are taking it on an empty stomach. Want an easy solution?
Take an over the counter kids chewable vitamin instead! They usually have the same vitamins as your prenatal – it’s just in chewable form. They also don’t make women as nauseous as some of the larger pills. (Sidenote: most gummy vitamins do NOT have iron – check your labels!)
Do you know why folic acid is recommended when you are trying to become pregnant? Because the neural tube (think the baby’s brain to spinal cord) forms very early in pregnancy. Often, before women know they are even pregnant. The neural tube closes around 10 weeks of pregnancy though! So there is a very small window to ensure you are getting the recommended supplement.
Iron is needed all throughout pregnancy. It’s a source for the baby to make their own red blood cells! Iron deficiency is very common in pregnancy but can be easily prevented. If you want to know more about preventing anemia in pregnancy, check out the 28 week visit post:
Tip #10: Gain the recommended amount of weight during pregnancy.
Only 32% of women gain the recommended amount of weight…48% of women gain too much weight and 21% don’t gain enough. Too much weight gain is associated with a larger baby, a cesarean birth, and obesity in your baby’s childhood; too little weight gain puts babies at risk to be too small for their age, have breastfeeding difficulties or even developmental delays.
Think of weight as a vital sign for you pregnancy. Weight gain recommendations are based on your starting body mass index and should be reviewed at your first prenatal visit. Here are the recommendations…
- Underweight (BMI <18.5): 28-40lbs
- Normal weight (BMI 18.5-24.9): 25-35lbs
- Overweight (BMI 25.0-29.9): 15-25lbs
- Obese (BMI >30.0 or greater): 11-20lbs
Still wonder how all the weight is distributed? (No, it’s not all baby and boobs!). Here’s the spread on an approximate 30 pound weight gain:
- Baby 7.5lbs
- Uterus 2.0lbs
- Placenta 1.5lbs
- Amniotic fluids 2.0lbs
- Breast enlargement 2.0lbs
- Extra blood and fluid volume 8.0lbs
- Extra fat reserves 7lbs
Tip #11: Prevent anemia.
Every pregnant women is screened for anemia at the beginning of the pregnancy and at 28 weeks gestation.
Anemia is when you have a lower amount of red blood cells in your body. Red blood cells are important to your body because they carry oxygen to your cells (ACNM, 2018).
The most common causes of anemia in pregnancy and the postpartum period are iron deficiency and blood loss. Iron deficiency anemia is associated with low birth weight, preterm delivery and perinatal mortality (AAP & ACOG, 2017).
Treatment for iron deficiency anemia requires an iron dosage of 60 to 120mg daily and you can increase your iron with iron rich food or iron supplements (AAP & ACOG, 2017).
Iron rich foods include: meats, eggs, fish, beans and fortified cereal or grains.
Iron supplements include: ferrous sulfate, ferrous fumarate or ferrous gluconate. One supplement does not work better than the other. Beware of common side effects: constipation, nausea, stomach discomfort, bowel changes (ACNM, 2018).
Another few reasons why iron supplementation is important:
– Iron supplementation may help prevent a blood transfusion if your bleeding during birth is more than normal!
– Your baby needs iron too to build their own red blood cells!
– Postpartum healing involves oxygen delivery to your damaged tissues to heal/repair after birth.
– Significant anemia can lead to insufficient milk supply if you desire to breastfeed.
Be sure your prenatal has iron in it and try to eat dietary sources of iron throughout the pregnancy and postpartum periods as well!
Tip #12: Protect yourself from lower nerve extremity injury during birth.
Lower nerve extremity injury in birth is uncommon but it’s often very overlooked. Damage to the nerves is can take place anytime during your birth, whether you have a vaginal delivery or cesarean section. Most commonly, damage occurs during the pushing stage when a woman pushes for a long time or her legs are pushed too hard backward, over and over. Prevention is very easy and you can take the first steps to protect yourself during birth. Read this prior post What is Lower Extremity Nerve Injury? and download the LENI prevention tool here to include in your birth plan when you go the hospital.
Tip #13: Get your dental care scheduled!
Did you know?
– Pregnancy can increase your risk for gum disease and pretem birth (birth before 37 weeks). Why? Increased blood flow to the mouth increases the amount of bacteria that can be transported from the gums to other areas of the body and cause infection/inflammation.
– Dental care is recommended during pregnancy; most insurance companies cover a cleaning every 6 months in pregnancy.
– Dental x-rays safe during pregnancy but may not be included in your routine care.
– Dental work (cavity repair, etc.) is also safe in pregnancy – most dental work is one in the 2nd trimester.
Be sure to tell your dentist…
– That you are pregnant! Even if you are few weeks pregnant and not showing, it’s important to tell your dentist.
And don’t forget…
– To brush your teeth twice a day and floss (some increased bleeding of the gums is normal >>> this is from the increased estrogen from the pregnancy! If you are having lots of nausea/vomiting and tooth brushing makes you want to puke, try brushing your teeth at a time of day you are feeling well. Of, try rinsing your mouth with 1 teaspoon of baking soda in 1 cup of water (rinsing reduces the amount of acids in your mouth).
– Have trouble remembering to floss? By a bag of floss sticks and put them in your car; be that mama that’s working on her dental care at stoplights!
– Eat healthy food during your whole pregnancy!
– To consider breastfeeding to improve your BABY’s teeth health! Breastfed babies have stronger teeth!
March of Dimes. (2019). Dental health during pregnancy. https://www.marchofdimes.org/pregnancy/dental-health-during-pregnancy.aspx
Tip#14: Prepare for birth by reading these books.
If you haven’t realized, I recommended reading a lot around here! These are the ones I recommend over and over…and over. Save some money and buy them used on ebay 🙂 Google is not where you are going to find you answers to pregnancy, birth and postpartum periods. You have to put some effort in too and find high quality reading material! If you only had time to rad 3 books, my top three recommendations are:
1. Mindful Birthing
2. The Birth Partner
3. Ina May’s Guide to Childbirth
Want more ideas? Check out the BOOKS & MORE page here.
Tip #15: Relieve your round ligament pain.
Anyone struggling with round ligament pain?!
– Round ligament pain is common in pregnancy and usually starts at 14 to 16 weeks but can occur well into the third trimester.
– The round ligaments connect the uterus to the groin. They insert at 10 and 2 o’clock at the top of your uterus and stretch all the way down to the middle of your pelvis.
– Walking and changing position (rolling over in bed, moving from sitting to standing) are common causes of ligament pain.
– For relief, try these yoga poses: cat-cow, pelvic tilt, and savasana. Stretches right before bedtime for 10-15 minutes seem to be the most helpful – daily stretching is the key!
– For additional relief, try a heating pad, warm bath, pregnancy support belt (not a stretchy band that stretches over your belly) and rest.
– For persistent pain, consider asking your provider about a physical therapy consult – therapists can work to help manage your discomfort and to teach proper positioning during your pregnancy. I highly recommend this especially if your discomfort or pain is getting worse as your belly gets bigger.
I usually add a support belt around 20 weeks at work for the 24 hour shifts. It helps with the back pain too. Even if you have to take the belt off every few hours or more to pee!
Tip #16: Eat some dates! Ripen that cervix!
Eating 6 dates (about 70 grams) a day, starting at 36-37 weeks of pregnancy, in low risk pregnancies, has been associated with:
- Shorter early stage of labor
- Lower chance of postpartum bleeding
- Lower chance of needing augmentation (help to contract) or induction (to start contractions)
- Lower rate of vacuum assisted birth
- Lower chance of presenting with your bag of water broken
- A higher Bishop score on admission (a more favorable cervix)
Studies varied as to the type of date recommended (types of dates can vary depending on the country) and some studies used dates or date syrup.
You can eat the dates by themselves, chop them up in oatmeal, or drop them into a smoothie.
Be sure to run any concerns or questions by your provider.
Evidence Based Birth offers a nice review of dates (and castor oil) on their podcast episode 128!
Tip #17: Decline the stirrups!
Decline you say? I don’t have to give birth on my back and in the stirrups. Yep! Stirrups were normalized during the medicalization of birth (when birth moved into the hospital). There weren’t stirrups in peoples houses when home birth was the standard…
Officially, if you need a vacuum or forceps to aid in your birth, stirrups are used to maximize the effectiveness of those methods. And for laceration repairs, they are sometimes needed as well. So don’t discount the use of the intervention as appropriate.
But for the birth of your baby, they are generally not needed. If you have a dense epidural and need help holding your legs, your nurses, family members or providers can help with that. If you are rocking a natural birth, you can get into whatever position your body tells you to come pushing – and don’t hesitate to switch it up.
Not sure how to ask? Simply say “I would prefer not to be in the stirrups for pushing or birth. I’m open to your suggestions on pushing and birth positions!”
Tip #18: Pack up clothes that don’t fit during pregnancy, order/borrow new ones if needed.
Put all those clothes that don’t fit during pregnancy or postpartum in a basket and stick it in the back of your closet! This will save you so much frustration, angst and longing (hello favorite J Crew shorts, I’m thinking of you!). And…it will make it easier to get dressed! Feel free to add to the pile as your bump grows during pregnancy or slowly returns to post-pregnancy norms after baby.
Tip #19: Use Epsom Salts!
What are they? What benefits do they offer? Who uses them? Are they safe for pregnancy? Let’s dive in!
What are epsom salts?
*Epsom salts are magnesium. They are also commonly known as “bath salts.” They come in a variety of styles, colors, and scents. You can generally buy a 8-pound bag at Wal-Mart or similar store for $7-8. I personally like the Dr. Teal brand in lavender and eucalyptus. They make your bathroom (and you) smell amazing!
Who can use epsom salts?
*Anyone; there are big benefits to pregnant and postpartum women. I’ve also used them for many years after long or hard runs while marathon training and think they help with recovery quite a bit!
What benefits do epsom salts offer?
*Epsom salts offer benefits to just about everyone and have a very little risk or harm associated with them (see below for the review of evidence).
*For non-pregnant individuals, they can help with muscle soreness after a tough workout or a long car ride, relaxation before bed, sleep, and GI issues like hemorrhoids or constipation.
*For pregnant patients, the list is similar: common aches and pains of pregnancy; hemorrhoids; muscle strains; constipation, swelling; and sleep.
*Postpartum, epsom salts are recommended as “sitz baths.” A sitz bath is a warm water bath filled only to 4-5 inches; then 2 cups of epsom salts are poured into the bath. The woman then sits her bottom and legs into the bath to soak for 15 to 20 minutes. Sitz baths are lovely for anyone who has had a baby – especially for a mama who has a very sore bottom or had stitches to repair a vaginal laceration. I’ve seen people recommend sitz baths daily to up to 4 times a day. Again, there’s very little harm and the bathtub is a nice place to clean up the normal postpartum bleeding that is inevitable…The other benefit I loved with sitz baths was the 20 minutes to soak, rest, relax or read – really, just to take a little relaxing break from the needs in the newborn period and give myself some self care. It was lovely.
#pregnant #pregnancy #birth #postpartum #swelling #relaxation
Tip #20: Expect shared decision-making as the standard.
Did you know: Patients whose providers listen to them, elicit goals and concerns, and explain ALL the options, are 3-5 times more satisfied with their providers? TRUE!
Shared decision-making is a process in which the patient and the provider discuss a treatment plan based on evidence (or lack of evidence); the patient and the provider then weigh possible risks and/or benefits of the treatment plan against the patient’s values. The whole idea is that the patient and provider are having a conversation together about the plan of care (National Learning Consortium, 2013).
*Why is shared decision-making important? The short answer: in healthcare, there’s not always a right answer or just one option. It’s important for providers to review all possible avenues for care and for patients to understand that they have a choice. Additionally, patients that are vested in their plan of care are more like to stick with their treatment or care plan!
*When patients participate in shared decision-making….*
– They understand their condition or problem
– They recognize the need to make a decision and that they understand all options
– They understand the pros or cons of each option
– They feel more confident talking to their provider
– They are more likely to follow through with their plan (National Learning Consortium, 2013)
*Why does shared decision-making matter in pregnancy and birth?*
Because your pregnancy and your birth should involve your values, opinions and choices. Often times, there is evidence for birth interventions, often times, there isn’t. It’s imperative you know when to ask why something is being done and consider that the intervention or treatment might not be appropriate for you, your baby, or your family. Consider asking these questions:
– Have we reviewed all the options and the risks/benefits of each option?
– When do I need to make a choice?
– Do I know everything I need to know to make a decision?
– What are my personal values regarding this decision?
That’s a wrap for the tips! Did you learn something?
Should I keep the tips up on the insta? Let me know!
Don’t forget the offer above too – if you’re a mama who has some thoughts about how pregnancy care or education could be better, I’d love to chat!
1 year ago on the blog…How to Recover From a 24 Hour Shift
2 years ago on the blog…Friday Five (#24) – Do you love this post? All of. theFriday Five content moved into the newsletter – be sure to subscribe to keep up to date!