When Your Body Knows Just What to Do

 

Midwife seeing mother for pregnancy examination

Midwife exanimating belly of pregnant woman with CTG scanning in practice

I just read Gloria Lemay’s blog post “Are You A Good Candidate For A Hospital Birth?” and it really got me thinking about how to reach more people to help them understand the range of choices that exist for childbirth. I think if first-time moms really understood the challenges inherent in a hospital birth experience, they might think twice. At least, the idealistic part of me thinks that – the part of me that includes my own personal experiences with giving birth in a hospital, as well as the differences when I later chose to have a child at home.

Some moms are content to not think about the choices. Some moms know both perspectives and choose the path more well-traveled by their peers. Others, like the pre-homebirth me, think that if you want a natural birth at the hospital, you can tell the staff your wishes when you arrive and it will just happen. I get it it: there is immense social pressure to conform, especially when family members or friends say things like, “Choosing homebirth is a selfish choice!” (Yes. Really. People say that.)

So, let’s get real. Let’s drill down and take a look at aspects of hospital births that many women may not have considered. I find Gloria Lemay’s list of questions from her blog post “Are You A Good Candidate For A Hospital Birth?” to be a good place to start:

  • Must not be scared of needles.
  • Must not be claustrophobic or uncomfortable in confined spaces.
  • Must be able to go for long periods of time without eating or drinking.
  • Must be happy to share a bathroom with others.
  • Must enjoy sleeping on a mattress covered with plastic.
  • Must not have a rebellious or questioning nature.
  • Must accept the possibility of contracting antibiotic-resistant infections.
  • Must be confident with caregivers who are overtired and overworked.
  • Must realize that a limited amount of time can be spent in a hospital room before it is needed for the next patient.
  • Must like and trust electronic equipment.
  • Must be comfortable with a cesarean rate of 30%.
  • Must accept that the mood of the nurse on duty will be a large determinant of the birth outcome.
  • Must realize that someone you have never met before will likely receive your baby.
  • Must realize that the written birth plan will be ignored.
  • Must be willing to have fluorescent lights turned on at all hours.
  • Must be capable of birthing without making loud noises.
  • Must look good in a flimsy blue gown that is open up the back.
  • Must be willing to be a teaching subject for student doctors who are learning to do pelvic exams, surgeries, and suturing.

Do women know that this is what they have chosen when they choose to birth at a hospital? Are they so afraid of the process of birth that they’re willing to give up their safety and their preferred birth experience to a system that promises outcomes for them and their babies that are worse than every other industrialized nation? What motivates women to make this choice?

I ask these questions of myself as well. Why did I choose hospital birth for my first three babies? Maybe that’s a good place for me to start as I grapple with ways to address the fundamental differences between hospital births and other birth setting births.

With my first baby, I wanted the best possible care, which, to me at the time, meant the most expensive care: an obstetrician. I thought midwives were somehow “less than” and that homebirth was dangerous. The internet didn’t exist in the average home in 1989, so the ability to make a truly informed choice was limited. My preconceived notions about midwives and uninformed opinions about homebirth and obstetricians drove my decision to seek a hospital birth with an OBGYN. Looking back I can see that I wasn’t informed and armed with facts; rather, I was making decisions based on cultural bias and confusing messages in the media and in books.

In addition, as a headstrong only-child who thought she knew it all, I believed I had fully prepared myself for a natural birth. I thought that if I informed the hospital staff of my plan when I arrived, it would happen the way I wanted. I had read good books about natural birth (Birth Without Violence, Childbirth Without Fear), but “What to Expect When You’re Expecting” had just been published for the first time. It was the new mom book of the day and I practically memorized the book by the end of my pregnancy. I felt like I really knew my stuff going into the birth. In retrospect, it wasn’t really the best choice of reading material, to say the least. Some people joke that it teaches pregnant women how to become “obedient” patients. And that just might be true.

My first birth was anything but natural. There were a lot of medical interventions. Yet active labor was fairly quick. I had a vaginal birth with no episiotomy, so I felt like I’d done pretty well. I hadn’t had an unmedicated birth, but, in the end, I felt like the reasons for that were my own failings, not the failings of the doctor or the hospital, and that they had “given me” as natural of a birth as they could-despite my “inadequate” contractions and “inability to tolerate” the pitocin-augmented labor. What I experienced emotionally was this: feeling a bit deflated, taken down a peg, proven wrong, (See, natural childbirth really is too tough for you) proven to be defective (Your body needed “help” to give birth.) Despite all of these feelings, I convinced myself I’d had a good birth. It was a defense mechanism that helped me deal with the bigger truth. It helped orient me in the cultural norms of childbirth that I butted up against in the hospital. It helped me to let go of my original feelings, preferences, and instincts about how I wanted to birth.

With my second baby, I did as I had done with the first. I told myself I was pretty happy with the first birth experience (I didn’t know anything else), so I went back for more of the same. One big difference this time around was that I was even more financially strapped than with my first; I ended up on Medicaid. I lived in a rural area at the time, and the only obstetric providers who took Medicaid were doctors at a Family Practice clinic. I was served by a large group of residents at the clinic; my birth was attended by a few residents. I felt as if they had no real expertise with childbirth, and that I was just someone for them to practice on. The birth was a tough Pitocin-augmented, persistent posterior birth with no pain relief. I was restricted to lying on my back or my side, which made labor excruciating. I left that birth not ever wanting to go through that kind of pain again.

So, now fearful of birth, for my third birth I chose a birth I felt I could better control-a scheduled induction at 39 weeks with an epidural at 1cm. There wasn’t much pain, but instead of feeling in control, my stated goal, I felt totally OUT of control. I had no physical sensations of birth, which meant no feedback on how the labor was progressing. I felt disconnected from the experience and totally at the mercy of how the doctor felt about my progress. It was horrible.

The turning point for me, and the biggest impact on my decision to choose a homebirth with my 4th baby, was my involvement with La Leche League. I listened to the experiences of other mothers and learned that doctors don’t know everything. I heard other mothers describe the same birth experiences and I finally began to question whether my choice to give birth with an OB in the hospital had really been the best option for me, especially when my stated goal had been natural birth. The stories of these other mothers helped me to see that it was not my body that had failed me, but the obstetrical system that had failed me. The clincher for me was on the day I told my OB that I was interested in taking Bradley Method childbirth classes. She grabbed me by the shoulders and said, “Kim, tell me you are NOT having a natural birth.” I nearly ran away screaming. It was clear that she was not going to support my choice.

I made an appointment with the midwives at BirthCare and Women’s Health in Alexandria. It was life-changing. At the first visit, I knew it would be a totally different journey. Our first visit with the midwife lasted an hour. It was my first experience of a provider actually listening to me and asking questions that other providers had not asked before. When I left that first visit, I felt a peace I had not felt previously about my maternity care. I knew that even though it would probably be out of pocket financially for me to have the baby at home and that the drive for prenatal visits would be over an hour each way, it would be 100% worth it. And I was right.

Charlie’s birth was an incredibly beautiful family event. Birthing at home, connected to my body’s innate wisdom, helped to heal the pain I carried with me from previous births. Finally, I did not feel defective! My body had known all along how to give birth, not unlike it had known how to nourish and nurture my babies through breastfeeding. I’ll never forget that moment when the midwife whispered in my ear after the birth, “See, Kim, your body knows just what to do.”

I’m an intelligent, educated woman. Heck, my great-grandmother was a midwife! I don’t consider myself to be one to bury my head in the sand when it comes to making important decisions. So I ask myself now, what could have helped me to know the truth sooner? To become more aware of the cultural implications of birth? Maybe if I had read Gloria Lemay’s blog back in 1989, or maybe if I had viewed the Business of Being Born, maybe, just maybe, I would have understood the truth about giving birth in the hospital-the limitations, the restrictions, the very philosophy of institutionalized childbirth. I think the best thing we midwives and birth activists can do is to just keep spreading the truth, whether it is in a big way, through documentaries and books or movements, or simply sharing stories and making a difference, one woman at a time.

*Some women require obstetrical interventions in order to have a good outcome. This post is not directed at women who have benefited from necessary intervention-intervention we rely upon obstetricians to provide with their surgical and high-risk skill sets.

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The Fourth Trimester

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photo credit: Birthing Beautiful Communities

When a newborn emerges from the womb, it leaves behind a warm, dark, and physically stimulating environment that includes the mother’s heartbeat, the sounds of children or other adult voices, and the rocking, jostling, and rhythmic steps of the mother moving about. Upon birth, a baby will turn toward the familiar sound of its mother’s voice. We teach new parents to lay the baby down in quiet rooms, away from noise and the hustle and bustle of life, away from the mother’s familiar heartbeat, but what if what they really need is more of what they experienced in the womb?

The concept of a fourth trimester was first communicated by British childbirth educator and author, Sheila Kitzinger, in 1975: “There is a fourth trimester to pregnancy, and we neglect it at our peril. It is a transitional period of approximately three months after birth, particularly marked after first babies, when many women are emotionally highly vulnerable, when they experience confusion and recurrent despair, and during which anxiety is normal and states of reactive depression commonplace.” And other anthropologists like Jean Liedloff, author of The Continuum Concept, have studied multiple cultures or indigenous populations, looking for answers for problems faced by mothers and babies during the fourth trimester and beyond.

The fourth trimester concept embraces the idea that human babies are born three to four months earlier than developmentally ready. With evolution, the human brain has grown larger, but the woman’s pelvis has not. Thus, babies are born when their skulls are approximately eleven centimeters and before they have the muscle control to hold up their heads or roll over.

A friend who recently had her first baby remarked that while she had probably over-prepared for the birth, she hadn’t prepared at all for the first three months. Women no longer live and work in the same environments; we don’t see parenting up close with our communities or do as much caring for younger children as we once did when families were larger and life was more communal. We’ve moved into the workplace, attending college at large numbers, and waiting until our thirties (on average) to have children.

The transition from baby-in-the-womb to baby in the room can be just as jarring for today’s new mother as for the baby.

Buzzwords and parenting trends come and go, but the needs of the baby and new mother remain constant. During the fourth trimester, the mother faces: changing hormones, physical and sometimes emotional recovery from the birth, an initial unusually heavy period, soreness, moodiness, sleep deprivation, feeding and caring challenges with the baby, and, frankly, a world turned topsy-turvy. First time mothers are adjusting to the fact that every decision they make—even slipping into the bathroom to shower—impacts another person. Essentially, her life is no longer focused on her own wants and desires. More than men, women’s lives are greatly disrupted and reshaped by the arrival of a child, especially in the first months after the baby’s birth.

Both mom and baby are thrust into a new world, requiring adjustments, time, and a steep learning curve. If it’s a first baby, the learning curve is steep, but even consecutive babies create a learning curve, given personality and developmental differences baby to baby.

didymos-baby-sling-baby-carrier-baby-brightThe concept of the fourth trimester helps during this vulnerable time of change—looking at the early months through the eyes of the newborn, with empathy, helps the new parents in terms of setting expectations and making decisions. For instance, babywearing, especially with cloth wraps, can soothe even the fussiest of babies. The baby returns to the familiar warmth, heartbeats, and movement of its mother in the wrap. Wrapped securely, mothers can grocery shop, take care of older children, walk around the house, prepare food, or rest on the couch while the baby naps in its familiar cocoon. Some physicians and development specialists recommend swaddling to achieve a similar sense of security, but it remains more controversial in terms of neurological and motor development, especially if done for extended periods of time. One of my favorite wraps is the Didymos, but there are many types and styles of wraps on the market today and a mother might find that different styles are better for certain situations. For instance, for a quick errand at the store, a ring style sling might be easier to use. And babywearing can be a lifesaver with colicky babies.

Looking through the lens of the fourth trimester, it’s easy to see why a baby might nurse at uneven intervals; in the womb, the baby received nutrition continuously and in synch with the baby’s development. In the same way, a baby will nurse more when it’s making big developmental leaps, cutting teeth, or going through a growth spurt—as well as when it’s upset, scared, or angry. The media (books, TV shows, movies) often portrays sleep as something to be managed, when in reality, the baby knows what it needs and the sooner the new mother (and father) accept a more flexible approach to feeding/nursing, the easier the fourth trimester becomes. Full nights of sleep WILL return, but to expect full nights of sleep when the baby is young is contrary to its needs and development.

In the meantime, what makes sleep easier? Many families find that co-sleeping or using a side basinet works well. If breastfeeding, the mother gets more sleep when the baby is close by. And regular sleep/arousal cycles are healthy for infants and decrease the risk of SIDS. Every baby will sleep on its own when it’s ready. Managing expectations about sleep is just as important as managing the baby’s care. Attitudes should match development, not external schedules or sleep rules. These guidelines for safe co-sleeping can be helpful. Never sleep with an infant if the accompanying parent(s) have been using drugs or alcohol, as they may impair instincts and awareness. Dr. McKenna, an anthropologist and infant sleep researcher, cautions against co-sleeping when the mother is unable to breastfeed. In that instance, having the infant in the room in the early days will allow the parents to respond quickly to the baby’s needs. To learn more, check out McKenna’s Behavioral Sleep Laboratory at Notre Dame.

More and more research, as well as community programs, is focused on the concept of the fourth trimester. The University of North Carolina has a team of investigators looking at ways to improve outcomes during the first months of motherhood and infancy. Mothers and babies need support during those tender first months and health professionals are beginning to realize the importance of timely health encounters to reduce the incidents of post-partum depression, breastfeeding problems, and other maternal health issues. As women, we no longer live communally, but we can create a sense of community and support with our care providers, support groups (La Leche League or new parent groups for example), extended family, and friends who are already mothers.

Midwives see the care of the mother from a holistic perspective. From pregnancy to birth to postpartum, the midwife educates and supports the mother. It’s just as important that a new mother reach out to her midwife or care provider when feeling overwhelmed or unsure. Like the baby, the new mother is going from a constant environment—one in which she did things a certain way—to a completely changed environment. Support from other seasoned mothers and from health providers can be crucial to moving successfully through the final trimester and first months of motherhood.

(Locally, check out the Premier Birth Center postpartum support group, which meets every month in Winchester).

Natural Ways to Boost the Pregnant Immune System

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Pregnant women are more at risk for acquiring infection or viruses given the altered immune state that accompanies pregnancy. Most care providers and health agencies agree that the flu is a risk in late pregnancy and recommend certain types of flu vaccines. But there are also natural ways to aid the pregnant immune system.

Habits


Regular Exercise

Gentle exercise cleanses the lymph system and flushes bacteria out of the lungs. When the body heats up with exercise, it helps the body to fight infection. Breathwalking, yoga, swimming, and Tai Chi are gentle forms of exercise that are beneficial for pregnant women.

Sleep

The importance of sleep cannot be stressed enough. The body resets with sleep and a healthy immune system relies upon its restorative aspects. It can be hard to get comfortable in the third trimester when the baby gains the most weight just before birth. Sleeping on your side with a pillow between the legs is one of the most comfortable positions for sleep for the pregnant woman. Heartburn can also be a problem late in pregnancy. Be sure to eat small meals in the evening or drink tea with cinnamon or ginger or peppermint. If you find your sleep is interrupted at night, try to fit in a nap during the day.

Diet

A strong diet during pregnancy helps not only with immunity, but also with the size of the baby, which in the end can ensure an easier delivery. Check out our post on the optimal pregnancy diet and tips for eating healthy.

Hydration

Most midwives will tell you that hydration is key to a healthy pregnancy. Taking in enough fluids helps to flush your lymph system and keep your kidneys and bladder healthy, and water helps to form the placenta and the amniotic sac. Dehydration during pregnancy can lead to serious pregnancy complications, including neural tube defects, low amniotic fluid, inadequate breast milk production, and even premature labor. These risks, in turn, can lead to birth defects due to lack of water and nutritional support for the baby. Aim for at least eight 8-ounce glasses of water a day.

Hand washing

Be sure to wash your hands regularly. Anti-bacterial soaps are not recommended, but washing with regular soap is a good habit to develop while pregnant and when handling your newborn, postpartum. The most effective hand washing method involves lathering the backs of your hands, between your fingers and under your nails. Be sure to wash your hands after attending a group gathering or playing with young children.

Immune Boosters


Vitamin C

A master immune booster, Vitamin C helps immune cells mature; has an antihistamine effect; controls excesses of stress hormones, which suppress immunity; is antiviral and antibacterial; and raises interferon levels, an antibody that coats cell surfaces. In addition to Vitamin C supplements, the following foods contain the vitamin: papaya, bell peppers, strawberries, oranges, grapefruit, broccoli, pineapple, kale, kiwi, or Brussels sprouts.

Tumeric

Tumeric is the food that keeps on giving. Research has shown that it’s a better inflammatory than many OTC anti-inflammatory medications and equal to low dose steroids. High in antioxidants, anti-cancer by nature, good for digestion, and excellent at controlling inflammation, turmeric offers many immune benefits. You can add turmeric to smoothies, drink turmeric tea, or add turmeric to your favorite dishes.

Garlic

Garlic is a powerful natural antibiotic. One clove is powerful enough to combat infection, with its five milligrams of calcium, 12 milligrams of potassium, and more than 100 sulfuric compounds. It’s most powerful raw. If you feel a cold coming on or feel flu-like, try a raw garlic “shot:” one minced garlic clove in a small amount of water, chased by more water. Or, if you’re really ambitious, consider a shot of raw garlic, ginger, carrots, and lemon for a quick immune boost. Raw pesto is a wonderful way to get your raw garlic – toss on pasta or slather on a piece of toast or use in place of tomato sauce on pizza.

Healthy Fats

It’s important to obtain adequate essential fatty acids (EFAs) from the diet during pregnancy and lactation. DHA supplements, an Omega-3 fatty acid, based on cultured microalgae are available in many natural food stores. EFAs boost the pregnant woman’s immune system, support endocrine function and normal function in tissues, and lessen inflammation.

Linoleic and alpha-linolenic, key components of EFAs, cannot be synthesized in the body and must be obtained from food. Omega-6 fats are derived from linoleic acid and are found in leafy vegetables, seeds, nuts, grains, and vegetable oils (corn, safflower, soybean, cottonseed, sesame, sunflower). Most diets provide adequate amounts of this fatty acid, and therefore planning is rarely required to ensure proper amounts of omega-6 fatty acids. A less common omega-6 fatty acid, gamma-linolenic acid (GLA), has been shown to have anti-inflammatory effects along with other disease-fighting powers. GLA can be found in rare oils such as black currant, borage, and hemp oils.

Research suggests that fatty acids are needed for fetal growth and fetal brain development. The EFAs are important for infants as they ensure proper growth and development and normal functioning of body tissues. Increased omega-3 fatty acid intake in the immediate post-natal period is associated with improved cognitive outcomes. It’s important that the mother’s diet contain a good supply of omega-3s because infants receive essential fatty acids through breast milk.

Zinc

The body requires zinc for production, repair, and functioning of DNA – the basic building blocks of cells. Beans, nuts, breads, seeds, dairy, and some cereals provide zinc. Too much zinc is not beneficial, so if you consider taking zinc supplements, be sure to talk to your midwife or doctor first.

Vitamin D

Vitamin D supplementation during pregnancy and breastfeeding is generally recommended. Vitamin D plays a key role in the process of priming T cells to be ready to attack invaders and to fight infection. Sunshine, oily fish, and eggs are good sources of Vitamin D. If eating fish, it’s recommended to limit the servings to 12 ounces a week because of the exposure to methylmercury in most fish.

Almonds

Almond skin contains naturally occurring chemicals that help white blood cells detect viruses and even help to keep them from spreading. Almonds contain healthy fats, fiber, iron, protein, and magnesium. Almond butter is high in protein and good fats. It’s a good substitute for peanut butter and can be served on apples, crackers, or bread.

Chicken Soup

The old adage is true: eating chicken soup boosts the immune system. The broth and vegetables combine to provide anti-inflammatory benefits. Chicken soup decreases the duration and intensity of colds and flu by inhibiting the migration of white blood cells across the mucous membrane, which, in turn, can reduce congestion and ease cold symptoms.

Yogurt or Kefir

A healthy gut is an important building block of a healthy immune system. Yogurt and even better, Kefir, are full of probiotic benefits. Buy plain yogurt or kefir and add fruit-juice sweetened jam or fresh fruit and honey to avoid the high sugar content of commercial flavored brands.

Hot Lemon Water with Honey

Fresh lemon juice is an immune powerhouse, filled with Vitamin C, vitamin B6, vitamin E, folate, niacin thiamin, riboflavin, pantothenic acid, copper, calcium, iron, magnesium, potassium, zinc, phosphorus and protein. Squeeze the juice of one fresh lemon into a teacup, fill the rest of the cup with hot tea water, and sweeten with raw honey. This drink is especially soothing when you have a sore throat, cold, or sinus issues.

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Proper hydration, healthy diet, moderate exercise, and sleep are the building blocks of a healthy pregnancy. The basic prenatal multi-vitamin offers a lot of immune enhancing properties (don’t take a generic multi-vitamin as they often contain Vitamin A, which is contraindicated for pregnancy.) Experiment with some of these immune boosting tips, but most of all enjoy your pregnancy and let your midwife or physician know if you have any questions about immunity in pregnancy.

The Immunological Paradox of Pregnancy

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photo credit: Carmen Hibbins

For most women, navigating pregnancy is difficult. There are decisions to be made: maternity care, labor preferences, place of birth, newborn care, breastfeeding, etc. Not to mention vaccines. Currently the CDC recommends the influenza vaccine for all pregnant women. When making the decision to accept or decline the flu vaccine, it’s important to first understand a pregnant woman’s immune system, as well as the ingredients in different kinds of flu vaccines.

The immune system is a complicated system of cells, tissues, and lymphoid organs—a giant communication network. When cells receive alarms about antigens in the body (viruses, bacteria, parasites, fungi), they produce chemicals that seek to destroy the antigens ability to invade the body. Recently research has shown the importance of a healthy gut for a strong immune system – and for brain health. Really, we are only just beginning to understand the complexity of human immunity.

What we do know is that a woman’s immune system changes significantly from the moment of conception. The innate immune system, the immediate response part, is activated, which results in an increase in white blood cells (monocytes and granulocytes) and the pregnant woman’s production of natural killer (NK) cells decreases. Research has shown that a critical balance of immune cells as well the factors they produce are vital to a healthy pregnancy. Interfering with a pregnant woman’s immune responses is thought to have a negative effect, in particular in the early stages of the pregnancy. The decreased immunity and increase in white blood cells ensures implantation and the development of the placenta. Without it, the fetus can be rejected. Thus, the vast majority of vaccines aren’t indicated for pregnant women and they are generally avoided if possible.

The immunological paradox of pregnancy is complicated, delicate, and beautiful in the way only nature can be.

So what exactly are the risks and benefits of the flu vaccine? The benefit is easy to define: influenza poses a substantial risk for the pregnant woman, in particular during the later months of pregnancy. The woman’s altered immune state can leave her susceptible to certain infections and viruses, and when she contracts the flu it can be hard for her fight it. The CDC states:

Flu is more likely to cause severe illness in pregnant women than in women who are not pregnant. Changes in the immune system, heart, and lungs during pregnancy make pregnant women (and women up to two weeks postpartum) more prone to severe illness from flu, as well as to hospitalizations and even death. Pregnant women with flu also have a greater chance for serious problems for their developing baby, including premature labor and delivery.

The risks of influenza are real, despite the large number of women who have healthy, safe pregnancies without contracting the flu. So what about risks associated with the vaccine? Most of the research on vaccines is conducted on non-pregnant subjects, so researchers are careful to qualify results. The consensus tends to be: less vaccines overall for pregnant women, but the flu vaccine is indicated given the risks associated with the flu.

Current research focuses on the type of flu vaccines. Most flu vaccines are considered “non-adjuvanted.” An adjuvant is an additive used to increase the immune response to a vaccine. Adjuvant vaccines are important during pandemic times, as adjuvants allow more vaccines to be produced using less antigens and are therefore more cost effective. But adjuvants are pro-inflammatory and can aggravate other immune issues. Given the altered immune system of a pregnant woman, most researchers suggest that only non-adjuvanted flu vaccines be administered.

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The WHO organization issued the Safety of Immunization during Pregnancy report in 2014. The research is far from conclusive, but the WHO takes a careful look at results from studies around the world. In terms of the flu vaccine, they conclude:

Pregnant women and infants suffer disproportionately from severe outcomes of influenza. The effectiveness of influenza vaccine in pregnant women has been demonstrated, with transfer of maternally derived antibodies to the infant providing additional protection. The excellent and robust safety profile of multiple inactivated influenza vaccine preparations over many decades, and the potential complications of influenza disease during pregnancy, support WHO recommendations that pregnant women should be vaccinated. Ongoing clinical studies of the effectiveness, safety, and benefits of influenza vaccination in pregnant women in diverse settings will provide additional data that will aid countries in assessing influenza vaccine use for their own population.

If you’re pregnant, weigh the risks and benefits, and take into account any specific immunity issues. Is your immune system weakened for any reason? What is the risk of exposure? Do you tend to contract the flu? What is your family history in terms of vaccine reactions? Are you high risk for any other reason? Talk over the risks and benefits with your care provider. Ultimately, the decision is yours. Your pregnancy is your pregnancy, and a mother’s intuition is often the best guide.

If you choose to have the flu vaccine administered during your pregnancy, be sure that the vaccine is non-adjuvanted/inactivated. In the next blog post on Birth Outside the Box, we’ll discuss ways to naturally boost your immunity during pregnancy – ways to help you counteract the altered immune state that nature has carefully designed to ensure a successful pregnancy. Garlic? Diet? Sleep? Exercise? We’ll cover it all!