Herbs in Pregnancy

Herbs

We’ve written in the past about a pregnant woman’s lowered immunity. Good nutrition, sanitation habits, rest, and exercise all help to strengthen the pregnant woman’s immune system—yet she will inevitably be exposed to viruses and other immune challenges. Pharmaceutical remedies may prove too strong or be contraindicated in pregnancy, so we wondered about herbal remedies. What herbs are safe in pregnancy and what herbs should be avoided? We turned to an herbalist with training in the use of herbs during pregnancy and postpartum to find the answers. *

Before receiving clinical training in Herbal Medicine for Women, Julie Pettler worked as a physical therapist. Later, while teaching her young children at home, Julie built a large garden in her yard and began to keep bees. As her love of gardening grew, so did her fascination with the power of herbs—herbs that grow naturally and herbs that can be cultivated—to treat common ailments. “I study history, science, anatomy, and human health [as an herbalist],” Julie says. “Sometimes I walk barefoot through my yard to gather dandelion greens to add some bitter to my diet. Sometimes I order a strong tincture to stimulate a client’s lymphatic system.” In her current herbalist practice, she combines her love of teaching with her love of plants by leading workshops on foraging, herbal medicine making, the holistic use of plants for health and well-being, and the history and science of plant medicine. Studying herbs for women’s health combined another of her passions: advocacy for pregnant women and evidence-based childbirth.

We started the conversation by asking Julie when the pregnant woman can use herbs during pregnancy. “Herbs may be used for general nutritional support during pregnancy, such as with the use of pregnancy “teas,” and confidently used to address common mild discomforts such as nausea, itchy skin (topical use), and heartburn,” she says. “If a more serious issue arises during pregnancy, herbs may be considered in consultation with a knowledgeable practitioner.”

Julie offered a list of categories of herbs traditionally avoided in pregnancy. “Stimulating laxatives, such as Cascara sagrada, [and] aloe and rhubarb should not be used during pregnancy.” She suggests instead non-stimulating bulk laxatives such as flax or psyllium. Tansy, Mugwort, wormwood, and yarrow stimulate menstrual flow and should not be used. Julie points out that the literature on the safety of herbs in pregnancy is often conflicting, so she suggests a conservative approach to the use of herbal remedies.

The following are some of her suggestions for use in pregnancy:

Nausea

Nausea is a common complaint among pregnant women, in particular in the early months. Julie recommends ginger. “It’s the most studied herb for nausea in pregnancy,” she says. “And the studies support the traditional use of ginger.” Ginger can be taken as a tea (simply shaving fresh ginger into a teacup and steeping it in hot water, can create the tea), as ale in the form of ginger ale with real ginger, in capsule form, or as a candy.

Colds and Flus

For immune support, Julie recommends Echinacea initially, at the first sign of a cold or a flu. “It can be combined with elderberry for extra immune support,” she says. “If a cold or flu sets in, Echinacea should be discontinued. Many times though, the use of Echinacea will prevent illness.” Echinacea is best used for a short duration and can be taken in tincture form every few hours for two-three days.

Pregnancy Tea for Uterine Support

Pregnancy teas support and tone the expanding uterus in the second and third trimesters. Julie recommends equal parts Red Raspberry Leaf, Nettle Leaf, Oat Straw, and Alfalfa (measuring one cup combined). Using one quart of boiling water, cover and steep the herbs overnight to make the nourishing tea.

Postpartum

Julie suggests using herbs for after pains and for healing and antiseptic support of the perineal tissue. Antispasmodic herbs include chamomile, catnip, motherwort, and cramp bark, and can provide relief from after pains. Sitz baths, warm compresses, or peri-rinses to support the perineum postpartum can be made using comfrey leaves, calendula flowers, lavender flowers, sage leaf, yarrow blossoms, and rosemary.

A longitudinal study in 2001 on the use of pharmaceutical medications in pregnancy concluded that 91% of conventional medications had not been proven safe in pregnancy; physicians had inadequate information on the safety of medications in pregnancy. The World Health Organization studied the safety of vaccines in pregnancy and reached a similar conclusion—there are not enough studies conducted on pregnant women for obvious ethical reasons.

Most pregnant women have healthy pregnancies despite the lowered immunity. Herbs can provide a safe and low-risk option for women wanting to boost their immune systems when they’ve been exposed to a cold or flu, when they are preparing for birth, and during the early trimesters for nausea or in the postpartum period when their bodies are healing. “I love that the plants are simultaneously simple and complex,” Julie says. “I love the ways herbs can nudge our bodes toward health by nourishing us and supporting all of our body systems. This is an excellent time to slow down and embrace the healing power of plants.”

*Always consult with your healthcare practitioner before using herbs in pregnancy

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The Physiology of Birth

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photo courtesy of Adelaide Birth Photography

Birth is often a mystery—at least that’s what we’re led to believe. But closer examination reveals basic physiological truths that underpin normal birth for both the mother and baby. Certain truisms can indicate risk, such as a pregnant woman’s prenatal nutrition and medical history, but, in the end, birth is a complex orchestration of hormones, proteins, neurology, and basic psychology for the mother. The teasing apart of these elements allows us to understand the perfectly designed biological process of childbirth.

What We Know About the Onset of Labor

There is surprisingly little known about what causes labor. In the beginning of pregnancy, the woman’s immune system is suppressed to insure that the forming embryo implants successfully and the biological process sets in motion. In fact, if a woman’s immune system is too active, miscarriage can occur in the early months. Later in the pregnancy, when the baby is full term and labor begins naturally, though, there is less consensus about the exact cause of labor. Science is only just beginning to understand the onset of labor.

There’s strong evidence the baby may have something to do with initiating labor. When the baby reaches 32 weeks, a surface protein, a soap like substance or surfacent, coats the inside of the baby’s lungs to keep the alveoli open, a critical shift that will allow the baby to breathe outside the uterus. The surfacent consists of six fats and 4 proteins and continues to be produced until around the child’s eighth birthday, when the lungs are fully developed. Eventually one of the proteins, SP-A, is produced in the baby’s maturing lungs in utero. This protein activates immune cells (macrophages) to migrate to the uterine wall, creating a chemical, inflammatory, reaction, which may be the official start of a natural labor. Studies have been done with mice in which the SP-A is blocked; the mice remain pregnant beyond normal gestation. So, in a nutshell, the baby’s development—more importantly, the baby’s maturing lungs that signal when they are ready to breathe outside the uterus—may be the instigator, signaling for labor to begin.

On the mother’s part, hormones play an important role. Prostaglandin is the hormone that softens the cervix and oxytocin increases and triggers contractions. Also at play are estrogen, progesterone, cortisol, and CRH—corticotrophn. When the baby drops in the mother’s pelvis, the hormones assist, and the cervix begins to relax and thin.

The hormones; the baby’s position; and the immune cells, in concert with the uterus, all work together to trigger the full onset of labor. And hormones continue to work to the mother’s advantage as she progresses through the rest of the labor.

Hormones in Undisturbed Labor Defined

Any woman who has had a natural birth or observed a natural birth knows that undisturbed labor is intuitive and powerful, an intricate dance between mother and baby and the people assisting the mother. The mother often knows what she most needs, even in the most complicated of situations, because of the uninterrupted intuitive interplay between mother and baby.

Sarah Buckley, MD, an Australian obstetrician, writes and speaks extensively on the hormones at play in undisturbed birth. The key hormones in birth include oxytocin, beta-endorphin, adrenaline (epinephrine), and noradrenaline (norepinephrine), and are identical to the pattern of hormone release in lovemaking. “As the hormones of love, pleasure and transcendence, excitement, and tender mothering, respectively, these form the major components of an ecstatic cocktail of hormones that nature prescribes to aid birthing mothers of all mammalian species,” Buckley writes in “Gentle Birth, Gentle Mothering.”

The cocktail of hormones build up and peak around the time of birth or soon after and subside and reorganize over the hours and days after the birth. All of these hormones are produced primarily in the hypothalamus and each serve an important function in natural labor: oxytocin, the love hormone, stimulates contractions, and higher levels of oxytocin are also beneficial for contracting the uterus after birth to prevent hemorrhaging; beta-endorphin serves as a stress hormone, more specifically as a pain-reliever that in high amounts can slow the production of oxytocin, thereby helping to modulate the pain of labor; and adrenaline and noradrenaline—fight or flight hormones—rise at the end of labor, giving the mother extra energy for the pushing and initiating the ejection impulse necessary for the final stage of labor.

Karen Strange, CPM, who teaches NRP training from the baby’s perspective, teaches birth workers to observe and expect the laboring mother to “pause” after the baby arrives. Strange teaches that there is a natural sequencing to birth for both mother and baby, and the pause or resting allows them to have a time of integration. Oxytocin, the love hormone, is at its highest in the hour after the birth, and mothers and babies begin the bonding process during that sacred hour. But noradrenaline also plays a role. “Noradrenaline, as part of the ecstatic cocktail, is also implicated in instinctive mothering behavior. Mice bred to be deficient in noradrenaline will not care for their young after birth unless noradrenaline is injected back into their system,” writes Buckley.

Why Environment Matters

Michael Odent, French obstetrician and surgeon, studied the environments for birth in the 1980s. He introduced low lighting, birthing pools, and singing into the birthing rooms at the hospital where he practiced in Paris. Eventually he became involved in home birth and started a research center in London. He found that low lighting, less observation, warm water, and a more homelike environment aided women in labor. Looking at the hormones at play—the very same hormones that are involved in lovemaking—it’s easy to see why a woman’s labor might be aided by the elements he studied. Traditionally women have birthed in a home, or even outside. The hospital environment became a new normal in the 20th century as surgical and other interventions began to rise, an environment Odent refers to as the masculinization of the birth environment.

Buckley writes, “For birth to proceed optimally, this more primitive part of the brain needs to take precedence over our neocortex—our “new” or higher brain—which is the seat of our rational mind. This shift in consciousness, which some have called “going to another planet,” is aided by (and also aids) the release of birthing hormones such as beta-endorphin, and is inhibited by circumstances that increase alertness, such as bright lighting, conversation, and expectations of rationality.”

Finely Tuned Dance

Low lighting, quiet, and support for the increasing irrational and more instinctual feelings of the birthing mother all support undisturbed labor. Midwives are trained to follow the mother. By following her cues and trusting in the complex orchestration of hormones, the healthcare provider receives vital information for understanding how the labor is progressing. What is most important is that the mother feels safe to travel to that other planet and that labor starts naturally and remains undisturbed. Biology most often takes care of the rest.

The physiology of birth includes a finely tuned dance between mother and baby, between immune cells and proteins and the uterine wall, and between the mother and her environment. If birth is treated more like a medical procedure, more like a masculine [refers to culture, not to men specifically] and rational endeavor, the more removed the mother will become from all the benefits nature provides. The physiology of birth, when allowed to proceed uninterrupted in normal birth, provides a hormonal roadmap for a successful birth and bonding.

“Giving birth and being born brings us into the essence of creation, where the human spirit is courageous and bold and the body, a miracle of wisdom.”

-Harriette Hartigan, midwife, author, and photographer

How to Get Healthy and Stay Healthy During Pregnancy

 

maternity-pictures-1_carmenhibbinsEach woman arrives at a new pregnancy from a different starting point. One woman may have planned for months to get pregnant, taking vitamins, eating healthy, and exercising. Another might be classified as medically obese and is worried about how that will affect her pregnancy—should she lose weight or focus only on eating healthy? While yet another may have, not intending or wanting a pregnancy at the time, been drinking heavily or using illicit drugs. Of course, most women are somewhere in the middle. Ultimately it’s most important that a woman work at getting as healthy as possible, so that she and the baby have the best outcomes.

So how does a woman who is already pregnant get healthy and stay healthy? And what are the risks if she isn’t healthy?

Lets look at the central tenets of a healthy pregnancy:

Good nutrition

Eating right helps to build a strong and healthy baby, and it helps the pregnant mom as well. A healthy diet can help to prevent high blood pressure, preeclampsia, gestational diabetes, and premature labor. A healthy diet can help to ensure against the baby growing too big, which could lead to a difficult birth.

Earlier this past year, we outlined a healthy diet for pregnancy. Be sure to eat plenty of protein and whole grains, and focus on color and variety in your fruits and vegetables during pregnancy. Good sources of protein include meats (limit seafood because of the high mercury content in many sources of seafood), dairy, eggs, nuts, beans, and seeds. And the less processed and milled the grains, the better. Drink plenty of water and salt to taste. Eat small, nutritious meals often. And, most of all, limit sweets and high-sugar-content food and drink.

A good prenatal vitamin is important for a healthy pregnancy as well. Prenatal vitamins are specially formulated for a pregnant woman’s needs. In particular, the pregnant woman needs at least 400 mcg of folate (higher if a BMI over 30) and Vitamin D. Folate in the first trimester helps the baby’s developing nervous system and strengthens the mom’s immune system. Vitamin D also helps with the mom’s immune system and helps the baby to develop strong bones and teeth before and after the birth. Vitamin D can be continued postpartum and can help to decrease the risk of postpartum blues.

What if a woman has a high BMI when she finds out she’s pregnant? There is no evidence that dieting to lose weight is good for mom or baby. In that case, she should focus on the healthy pregnancy diet, balancing the pregnancy needs for quality protein, whole grains, and plenty of fruit and vegetables. Many women who struggle with weight before pregnancy discover that eating healthy for the pregnancy helps them to maintain a healthier weight during and after the pregnancy. Most moms-to-be who have a higher BMI at the start of pregnancy can expect to enjoy a healthy pregnancy.

Exercise

Exercise helps the pregnant woman prepare for birth by strengthening and toning her body. It can also help to manage weight, and, combined with a healthy diet, can lower the risk of giving birth to a large baby. The adage is that if a woman already has a regular exercise practice, she can continue the practice. But, if the mom is new to exercise, low-impact exercise with a gradual endurance plan is just as beneficial.

The shift in the woman’s center of gravity and increase in joint laxity can make exercise more challenging. Water sports, such as swimming or low-impact water aerobics, can help support the pregnant woman’s body. Mild exercise in general can help the woman meet the greater oxygen demand that pregnancy creates. However, too aerobic of an activity can decrease her oxygen consumption and lower her overall oxygen volume. Ultimately, exercise can make pregnancy more comfortable and shorten the woman’s labor, and even reduce the need for interventions.

Exercise can also:

  • Reduce back aches
  • Reduce constipation, bloating, and swelling
  • Boost energy levels
  • Help with mood
  • Help with sleep
  • Prevent excess weight gain
  • Promote strength and endurance, which in turn helps the mother in childbirth

If the pregnant woman hasn’t exercised in awhile, but would like to add an exercise routine during pregnancy, she should start slowly, beginning with five minutes and building her endurance by five minute increments until she reaches a thirty minute practice.

What exercise should be avoided during pregnancy? Some forms of exercise are not advisable, such as:

  • Exercise that forces you to lie flat on your back after the 1st trimester
  • Scuba diving, which puts the baby at risk of decompression sickness
  • Water skiing, surfing, and diving, which cause you to hit water with a great deal of force
  • Contact sports such as ice hockey, basketball, volleyball, or soccer
  • High altitude exercise (less oxygen for you and the baby—and risk of altitude sickness, which causes headache and nausea)
  • Any activity that could cause direct trauma to the abdomen, like kickboxing
  • Hot Yoga or Pilates
  • Sports with a high risk of falling, such as downhill skiing, gymnastics, or horseback riding at fast speeds

A regular exercise practice during pregnancy can lead to an exercise practice postpartum, which can help the new mom shed weight and regain muscle tone and strength for her non-pregnant body. Exercise should be avoided for the first month while the woman establishes breastfeeding and recovers from the birth.

Education

In addition to prenatal counseling with a maternity care provider, there are several ways a pregnant woman can educate herself about pregnancy and childbirth:

Childbirth education (CE) classes

CE classes can help the pregnant woman stay focused on pregnancy-specific issues, such as nutrition, lifestyle practices, and preparation for childbirth. Some options for childbirth education classes include: Hypnobirthing, Birthing From Within, Bradley, Lamaze, Birthworks, Centering Pregnancy, Sacred Pregnancy, and others. Local doulas and midwives often have extensive lists of local childbirth education providers, and some midwives offer childbirth classes at birth centers and in their communities.

Books

Books are a powerful way for the pregnant woman to prepare for birth and to learn coping mechanisms for the changing nature of pregnancy. Some favorites include: Spiritual Midwifery, Ina May’s Guide to Childbirth, Diary of a Midwife, Birth Without Violence, Birth with Confidence, and Homebirth Cesarean. There are also literary memoirs about pregnancy and birth, and pregnancy loss that can be powerful and impactful narratives, depending on a mother’s perspective and needs.

Documentaries

Documentaries about pregnancy and childbirth often include interviews with experts, snapshots of individual women’s labors, and commentary on an overall maternity care system. Documentaries, if appropriate, can help children understand an upcoming birth and help pregnant women (and couples) make decisions about what they most want from the birth experience. Some of the better documentaries include The Business of Being Born, Orgasmic Birth, The Face of Birth, Birth Into Being: The Russian Waterbirth Experience, and Pregnant in America. Check out this TED talk by Ina May Gaskin, the international childbirth luminary midwife.

Support

Rhea Dempsey writes about the “circles of influence” that surround the pregnant woman—from friends and family to the wider culture. These circles ultimately impact the woman’s pregnancy and birth experiences.

The people with whom the pregnant woman surrounds herself make a big difference in how healthy, physically and emotionally, the woman will be during pregnancy. The following are important questions to ask:

  • Is the pregnant woman’s home a safe place?
  • Does she have emotional support?
  • Is she more concerned with the anxieties and fears of her mother, her sister, her husband, her friend, than her own?
  • Is the pregnant woman able to decide how and where she wants to birth based solely on her needs and wants?
  • Is her maternity care provider supportive of her wishes?
  • Can she ask questions without fear of belittlement or of her fears being minimized?
  • Does she have access to healthy food and clean water?

A healthy pregnancy hinges on physical elements such as a safe place to live, the opportunity to exercise, access to healthy food and clean water, and good prenatal care, but it also hinges on emotional health, and support is central to a pregnant woman’s emotional health. Support often means more listening than talking, and support means something different for every woman. And, ultimately, after pregnancy, the birth is most about the woman and her baby, not the people who surround her. Sometimes the best support is the most minimal support, support that allows the woman to decide how she wants to birth and who she wants to support her during the birth.

Getting healthy during pregnancy will mean something different for each woman. For instance, a woman who struggles with alcohol and drugs may need to first focus on addiction recovery. After she is clean and sober, she can move on to good prenatal care and nutrition, as well as creating a circle of support that is healthy and best for her and the baby. For a woman who doesn’t have good nutritional habits, getting healthy may mean focusing solely on nutrition and exercise. And for a woman who lives in an unsafe home, getting to safety may be the first step toward a healthy pregnancy.

Focusing on the main tenets of a healthy pregnancy will help a woman get healthy and stay healthy throughout pregnancy, with great benefits to both mother and baby.

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.

hot-lemon-water

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 Differences Between Hospital and Out-of-Hospital Birth

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People who have never given birth outside of a hospital may have no idea of the differences between hospital and out-of-hospital birth. What’s the big deal? You can have a natural birth in the hospital. Why would someone want to have their baby at a birth center or (gasp!) at home? The answer is not so black and white.

Can you have a natural birth in the hospital?

Well, that all depends on what you call “natural,” but yes, to varying degrees, you can have a “natural birth” in the hospital. There are many labor & delivery nurses who are excellent at supporting natural hospital births, and there are many doctors and midwives who are supportive as well. Some hospitals have adopted policies that are more tolerant (even encouraging) of birth plans or that allow doulas in the birth room. Those are steps in the right direction. And many women have found creative ways to ensure a natural birth, such as waiting until transition to head to the Labor & Delivery floor, or laboring while roaming the halls of the hospital with a labor coach (a partner or doula or friend). Of course, a birth plan as an avoidance of interventions, rather than as a vision of an ideal birth, seems to really miss the point in a lot of ways. Should birth really be about strategic plans for dodging unwanted interference in your baby’s birth?

Let’s break this down. You’ve hired your care provider because you’ve heard great things about them, they have a great reputation, their statistics are great.. etcetera… Pushing the boundaries within a set system is one thing, but can you ask your care provider to be someone they’re not? A great hospital-based provider is skilled at hospital birth and what hospital birth has to offer you. A great birth center or home birth midwife is skilled at the midwifery model care. The models are not the same. As anyone who has seen birth both in and out of the hospital will tell you, there are a few key differences between the two:

The provider on call attends the birth at the hospital.

If your care provider is part of a group practice, who will actually attend your birth? If it’s a combination of physicians and midwives, are you guaranteed a midwife to attend you? Are all of the providers on board with your birth plan? You may have a favorite midwife or physician in the practice, but what are the chances that your favorite provider will attend the birth?

Most out-of-hospital practices are solo providers, although some are small group practices. In a solo practice, there is a rare possibility that your midwife will be unavailable due to illness or family emergency-after all, we’re only human! If you hired an out-of-hospital provider, do you know who the backup provider is?

All of the above are important questions to ask as you consider your birth options and whether to give birth in the hospital or out. What is most important is that you are comfortable with your decisions and ultimately your birth experience.

In the hospital, it’s the nurses who take care of you, not the doctors.

You spent weeks researching practices, settling on the one practice you think will best support your birth plan. Your doctor is a local superhero. But, who takes care of you at the hospital?

During your time in labor, the nurses will take care of you. Nurses are the amazing unsung heroes in the hospital. They are the ones who do the heavy lifting (literally, as well as figuratively) in patient care. They’re often over-worked and underpaid. We love nurses, yet even though they are awesome, they are also people you’ve never met before. Nurses are the ones who will be with you, almost single-handedly helping you with your labor. What if your philosophies on birth don’t match? Nurses vary in their training in natural labor support techniques. How do you know if you’ll be the lucky mom to get the super nurse who really knows her way around a rebozo or who does her best to be at the bedside as often as possible? Answer: You don’t. It’s a roll of the dice.

Once you get to the hospital, you’ll be checked in by the L&D staff. If you are seen by a doctor or midwife, it might be a provider from your group, or it might be an OB hospitalist, a physician who only sees patients in the hospital and does not have a private practice. If you’re admitted, you’ll most likely be monitored and “treated” per your provider’s standing orders. It’s good to know beforehand what orders are standard for your care provider. Your nurse will keep in contact with your provider and will update and consult with them, as needed, typically by phone. If you have questions about the orders or want to refuse something, you will have to wait until the nurse can reach the provider.

The provider may briefly check in during your labor, but typically they are not continuously present until you are pushing and the head is visible. Their training rests on the ability to take action if something unexpected happens. They are surgeons and the best option for a high risk situation, which happens in a small percentage of births.

Out-of-hospital midwives are the people who take care of you at your home or birth center. Together, with a birth assistant, they provide continuous labor support from beginning to end – and they determine when and if you need someone as highly trained as an OB or a transfer to a hospital. Rather than treat every laboring woman as if they are the minority of women who have complications, out-of-hospital midwives treat laboring women as the if they are the majority, who will not have complications, all the while keeping an eye on whether a complication could occur and when/if to transfer the mother to an OB’s care – much like the maternity models in most of the developed world.

Your nurse is taking care of more than one person at a time.

No matter how awesome your nurse is, she is only one person, and is most likely taking care of multiple women at the same time. It’s not realistic to expect a one-on-one continuous physical presence and support from your labor nurse. The hospital system is set up with floors of patients who are typically divided among the nurses for twelve hour shifts. The care will fluctuate based on caseload, changing shift hours, and the preferences of the nurses in term of hands-on care. There will be no chance to meet the nurses who will attend you before you are admitted. And no choice in terms of which nurse is assigned to you.

On the flip side, hiring a midwife means that you have a chance to interview and pick the right provider for your care, including a back-up midwife. Whether the primary midwife or the back-up midwife, you will have a good sense of exactly who will be providing continuous labor support during your birth.

They work in shifts.

Nurses typically work in 12 hour shifts. Unfortunately, labor doesn’t often fit neatly within one 12 hour shift. Your labor will typically straddle two shifts, or maybe more. While getting through contractions, you may have to shift gears and adapt to a new support person- right before transition, or even right in the middle of pushing.

The typical out-of-hospital provider does not work in shifts. She’s there with you from the beginning to the end.

A different team takes care of your baby.

Every hospital has different protocols and rules about labor and delivery care. The nurses who attend your labor and delivery will likely not be the nurses who take care of your new baby. With the lack of continuity in care for the family, mistakes can be made, such as giving a breastfed baby formula or giving a baby a pacifier when the mom doesn’t want one offered to the baby (in the event it causes nipple confusion and adds stress to the new breastfeeding relationship.)

Usually, the father or another family member can be assigned to accompany the baby whenever he/she leaves the mother, to ensure that no unwanted procedures were carried out despite their wishes to the contrary. Even with this safeguard though, the pediatric team still can’t possibly know the whole picture.

They haven’t been with the family throughout the entirety of prenatal care and birth, so they don’t know you in the same way your midwife would.

Yet another team takes care of you during postpartum.

With midwifery care, the mother’s care, the baby’s care, and the family’s care are all provided by the same team. In fact, the postpartum care is also provided by the midwife who attended the birth.

A different philosophy.

You’re “allowed” to do something, you’re “not allowed” to do something. If your wishes conflict with a physician’s preferences, you might be asked to sign an AMA (Against Medical Advice) form, which can feel intimidating when in the throes of labor. It’s important to remember that hospitals are large institutions with rules and regulations that are applied to every woman, despite the wide differences between them.

Obstetricians handle emergency situations well. In emergencies, the obstetrician is the necessary authority and operates from that perspective.

But in the case of normal birth, the woman is just as important of an authority. When she is able to follow her intuition and pay close attention to her body, with minimal interruption, she can communicate valuable information to her caregiver.

Midwives are trained to respect this authority in normal birth. The philosophy of midwives is that the midwife/client relationship is a partnership and decision-making is shared.

A different outcome.

Hospital and out-of-hospital birth are two very different things. It’s hard for me, as someone who has had it both ways, and who has seen many births both ways, to minimize the difference in outcomes. Personally, my hospital births left me feeling less powerful and capable as a woman and new mother. My home births helped me to feel empowered, intelligent-like I was the expert when it came to my new baby’s needs. There really isn’t a way to quantify that kind of effect, or to easily measure how it impacts your mothering in the long run. Or even to measure how it affects the child long-term. It’s easy to measure the physical benefits of a natural birth.  But it can also have an unexpected and very healing impact on a mother’s life, just when she is embarking on new motherhood with a newborn. The unquantifiable effects of home birth may, in some ways, be the very reason that home birth is the optimal birth choice for so many women. And this may be the biggest difference of all.

Your Midwife’s Postpartum “Must Have” List

Baby SleepYou spend months thinking about preparing for your birth, but not much time is usually spent thinking about those first few days and weeks after baby arrives. Of course, most people have a pretty good stash of baby clothes, diapers, and fairly useless baby gadgets (thanks to the baby shower), but there are a few very practical items you might want to consider having on hand that may make your postpartum time a little bit nicer.

Good Nutrition

OK, this isn’t something you can just add to your baby registry, but it is something you should be thinking about and planning for prenatally. Plan to freeze nutritious meals ahead of time, and make up menu plans and grocery lists so people can pick up what you need an prepare good food for you while you’re resting with your baby. After your baby arrives, you’re going to need even more food than you needed when you were pregnant! Your body needs about 300 calories more per day when you’re nursing than you did when you were pregnant. This doesn’t mean you should just eat a bowl of ice cream every night and call it even. Your body is going through a period of recovery after the birth of your baby. The area where your placenta was implanted is an open wound, and it needs to heal. In addition to that very large open wound, you may have some trauma to your perineum or vaginal tissues that needs to heal. Wound healing requires plenty of protein, and vitamins A, C, E, and zinc. I generally recommend at least 100 grams of protein and 2000 mg of vitamin C for the first 6 weeks postpartum, and I recommend continuing your prenatal vitamins, probiotics, and essential fatty acid supplements as well.

Earth Mama Angel Baby Natural Nipple Butter

As a mama who has nursed plenty of babies myself, let me tell you that the best way to deal with sore nipples is prevention. Other than proper positioning and latch on technique (the MOST important things to avoid soreness), a good nipple salve can be extremely helpful in preventing soreness. La Leche League recommends Lansinoh, which is a great product, and some mothers swear by it, but I find it to be sticky and uncomfortable to apply to sore nipples. Earth Mama Angel Baby Natural Nipple Butter is an amazing product. It goes on smoothly, protects, and moisturizes. I’ve recommended it to a lot of women, and they’ve all raved about it. It is my #1 must-have item for postpartum. I recommend applying it after every feeding for at least the first two weeks.

Hot Water Bottle or Heating Pad

This is great for after pains, sore muscles, or to warm up the co-sleeper or bassinet (if you use one) before you put baby into it. There’s something really comforting about hugging a hot water bottle, but if you like an electric heating pad, the kind without the auto shut-off feature is really nice. Those are hard to find anymore. Just be really careful to keep it on a low setting and be sure to only use it when you’re awake.

Traditional Medicinals Smooth Move Tea

Sometimes, getting your bowels moving after the birth can be a bit of a process. Things can be a little sluggish, and then there’s the fear factor, especially if you have any stitches. Postponing the inevitable isn’t going to make it any easier. It’s important to make sure you’re drinking plenty of water, eating good non-constipating foods, and following your body’s cues rather than trying to avoid them. If you haven’t had a bowel movement within 24 hours after the birth, it might be good to give your body a little boost with some Smooth Move Tea. A nice strong cup of this stuff will usually get things moving within about 8 hours.

Depends

No, I’m not saying you’ll be incontinent after the birth! But, for the first day or so, your bleeding may be a little heavy, and the Depends Briefs are a great way to avoid leaking onto your bed during that heavier bleeding time.

Tucks Pads

Sometimes, when you’ve pushed out a baby, hemorrhoids become an issue, at least temporarily. Even without hemorrhoids, your perineum is likely to be a little sore after the birth. Tucks pads help reduce swelling and provide a gentle way to clean after using the toilet.

Abdominal Binder

After the birth, your stretched out abdominal muscles need some time and support to come back together. Sometimes, wearing an abdominal binder can this process and also provide much needed back support. There are several different ways you can go about doing this. You can just use a Rebozo (large piece of fabric tied around your belly), try Bengkung Belly Binding (beautiful!), or choose something more utilitarian like an Abdominal Binder that is used after abdominal surgery. All of these options accomplish the same purpose, but in different ways.

Postpartum Basket
I always recommend moms spend at least 2 days in bed after the birth. I’d love it if moms would take more bed rest, but 2 days is a good start. If you’re going to spend 2 days in bed, you’re going to need to keep some things nearby. Most moms find it hard to ask for help, so they either end up doing too much too soon, or they do without. I recommend putting together a basket of things you’ll want to keep nearby that you’ll want to have for the first couple of days after the birth:

  • Earth Mama Angel Baby Natural Nipple Butter
  • Nursing Pads
  • Spit up cloths (I used prefold diapers for that)
  • Thank You cards
  • TV remote
  • DVDs (or a Netflix Instant View subscription)
  • Book/Magazine that has nothing to do with baby, birth, or breastfeeding
  • The Womanly Art of Breastfeeding
  • Tissues
  • Tylenol
  • Ibuprofen
  • Thermometer
  • Diapers
  • Wipes
  • Hairbrush/Scrunchie/Whatever you need to make you feel like your hair looks decent
  • Makeup (if that makes you feel good)
  • Baby Book
  • Journal
  • Pens
  • Phone and charger
  • Camera (assuming your phone doesn’t have one)
  • Non-perishable snacks
  • Water bottles

I asked my clients what they felt helped them most during their early postpartum time. They came up with many of the same ideas I had, but they had some other suggestions:

  • “Extra peri bottles, one for each bathroom.”
  • Earth Mama Angel Baby New Mama Bottom Spray.”
  • “Comfy, baggy button-front shirts. In my case, the ones that are too worn for my husband to wear to work.”
  • “Breast pump for dealing with engorgement.”
  • “Phone number of my LLL Leader and midwife to call with feeding questions.”
  • “Pillow and blanket on each floor of the house so mama can nap whenever baby naps.”

My best advice is to think about what you would want to have that makes you feel comfortable, well-fed, relaxed, and supported. The most important jobs you have during your early postpartum time is to rest, heal, nurse, and bond with your baby. Everything you prepare ahead of time should support those goals. The only thing I wish I had done more of during my early days after my births was to take more pictures. Babies grow so fast! In just a few short weeks, your baby will change so very much, and you’ll want those pictures so you can remember that transformation.