Language and Birth

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Words matter. They settle deep in the psyche and impact our emotions, our beliefs – our overall outlook on things. This is never truer than with pregnancy and childbirth. All pregnant women, but especially a woman pregnant with her first child, is in new and unchartered space, and the people who surround her and the things they say impact her labor and first experiences as a mother.

Mind your words around a pregnant woman, and especially around a woman in labor.

Anthropologists and communication scholars write about two different paradigms of birth. Robbie Davis Floyd, Texas anthropologist and author, writes and lectures about the “technocratic” and “ecology” models of birth, arguing that there is freedom and space in the ecology model, but that in the technocratic model, the woman’s body is seen a machine and the baby as the product. Other researchers write about the “obstetrical” model, which includes the surgical training of obstetricians, versus the “midwifery” model, which includes the midwifery model of care and the importance of continuous support for the laboring woman. In each model you see a different lexicon of words.

For instance, who actually “delivers” the baby? It’s more common in the obstetrical/technocratic model to hear that the physician delivers the baby. But, the original use of the Middle English verb to deliver was passive. The Oxford Dictionaries site points out that “a woman was delivered of a child. When active use first arose, the midwife or doctor was the agent, and the woman the object: ‘they sent, and beg’d I would deliver her’ [1676].” In the beginning, deliver referred to the woman’s experience, whether liberation or rescue from the labor, or the woman freed from the burden of pregnancy. Next it moved to the active form that focused upon the woman’s agency in her birth experience, and today it has moved the main action to the attendant. “Dr. X delivered my baby.”

At the core, within the midwifery model, pregnancy is viewed as a natural life event for childbearing women. And out of that belief, words such as power, trust, love, empowerment, choice, and energy are often used to describe pregnancy and birth. There might be references to the power of nature/ birth or the power of the mother’s abilities in labor. Doulas and midwives use words such “rushes” or “waves” or “surges” to refer to a woman’s contractions, words that conjure up the image of a powerful ocean crashing against the seaside or strong electrical currents. And the midwife serves as facilitator, not director, in the mother’s natural life event.

By contrast, within the obstetrical model, pregnancy is viewed in terms of norms, with the male body as normal. Floyd takes this idea further by saying the woman’s body is seen as machine, the baby as product, and that pregnancy is something to be controlled: the doctor or midwife “deliver” the product through their control over the process with words like induce, intervene, and medicate. If the norm is to not be pregnant, then the labor needs to be actively managed. The action is focused not on the woman who is in labor, but on the staff who perform the management.

Somewhere in between is the reality of birth, right? There are times when a labor or pregnancy can move outside the norm of regular birth. While the woman’s body is designed for giving birth, labor can get complicated. In that case, the obstetrical model, with its emphasis on management and intervention and the provider in action, is a necessary model. But, given that approximately 90% or more (some researchers believe the more accurate number to be 95%) of women can give birth, can deliver their babies without intervention, why are obstetrical/technocratic words so commonly used? And why does it matter?

Women in labor are highly sensitive and intuitive. For example, if a woman is in active labor, moving quickly through the stages, and arrives at the hospital only to hear a nurse tell her that she won’t be giving birth until the next morning, guess what? The labor slows and the baby is born in the morning. If a soon-to-be-grandmother is anxious about the birth and present in the delivery room, the slightest slip of the tongue can have a negative impact on the laboring woman. If she says, “All the women in our family have cesareans, you’re no different,” the labor will be harder, the woman will have to fight against the negativity, and if not adequately prepared or supported, she might end up with a cesarean that may or may not have been needed if the words that surrounded her were positive and affirming. If a nurse tells a mother who is ready to push that the doctor needs to arrive to deliver the baby, the mother may lose her sense of agency over the delivery and the contractions may slow or the pushing become difficult.

The power of suggestion takes on a heightened meaning during birth.

In an article on the Birth International site, Abby Sutcliffe writes:

During labour, women are particularly alert to what is being said by caregivers. Even though she may look as though she is lost is concentration during contractions, the labouring woman will hear, often acutely, what is being said around her. She looks to the midwife for confirmation that she is doing well, particularly with handling the pain. A few well-chosen words of encouragement and support can be far more effective than [medication] in achieving relaxation and confidence in the labouring woman. The midwife at a birth has great influence on the woman’s reactions and impressions, so be careful not to introduce your own feelings and biases into the room. This woman is not a “poor thing” who won’t cope without you — she is a strong, innately capable woman uniquely designed for giving birth easily, safely and enjoyably. If you truly believe this then you won’t need to watch your language, you will already be consciously feeding this information back to through your language and responses.

Birth is a highly personal experience. Each laboring woman brings into the birthing room a personal story that includes the past birth experiences of the women in her family, her own hopes and fears, and any other past experiences that impact the natural process of birth, such as past sexual trauma or body image issues. Birth is a natural life event, a part of a women’s greater sexuality and biology. The words that she hears can help or heed her progress; it’s up to the people who surround her to make it the most positive and successful experience possible. Care providers: pay attention to the words you use around a pregnant or laboring woman. Family members and support team: think before speaking—everyone in the labor room should examine their own biases and experiences, their own fears, or even trauma that may not have been dealt with in the past. For the laboring woman, words really do matter.

Pregnant women deserve to feel supported and respected – empowered – to deliver her baby. No matter the final outcome—whether natural, or a birth with medication or a cesarean section—positive language in the birthing room puts the woman at the center of the action, so that she is in the best position to successfully deliver her baby.

 

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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

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

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!

The Shaming Has to Stop

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Get ready for a major soapbox post.

I get it. Those of us who choose to birth outside the box are different. We make choices that don’t necessarily follow mainstream society norms. Our choices may not be in alignment with what is embraced by the obstetrical model of care. Our choices may make medical professionals feel uncomfortable, challenged, exposed. I get it, really I do.

But…

That doesn’t give a healthcare professional the right to deny care in order to shame women and midwives, to bully us, or to punish us into submission because a laboring woman didn’t choose what the medical professional thinks we should do for ourselves, for our children, or for our clients.

Yes, this really happens. All. The. Time.

And, it never should. Ever.

For the most part, people who choose to give birth outside of the hospital feel that giving birth in a hospital is like using a sledgehammer push a thumbtack into a cork board—way too much fuss for something that most people can do on their own—and that a healthy woman having a normal birth in a hospital is asking for trouble. It isn’t that doctors have bad intentions. Most of the time, doctors and nurses have the very best of intentions. But, once a woman walks into a hospital, she will need to be “treated.” And, once a normal labor is “treated” (read, “interfere with”), risk is introduced.

People who choose to give birth outside of the hospital view the medical community as a necessary resource if the normal process doesn’t go normally. Most of us don’t hesitate to seek medical care if there is a need. Yet, why would a woman hesitate? Why do so many of home birthers/birth center birthers distrust the medical community? The lack of trust in the medical community exists because women have been burned many times, and women share their stories with each other.

As a midwife, I’ve personally seen patients yelled at, forced to have vaginal exams despite an explicit refusal, and verbally abused (put down, shamed, coerced, threatened). Doctors have yelled at me, attempted to discredit me in front of my clients, and threatened me with complaints. Why? Is it because something was done wrong? No, quite the contrary. All of these things happened because of a hospital transfer when a mom needed non-emergency help. Yes, these examples occurred during non-emergency transfer situations.

You might think, “Well, during a birth, the hospital staff acts this way because they worry about liability.” OK, let’s assume a medical professional was upset about that. Does that warrant abusive treatment of women and midwives? Quite honestly, does their bias or fear of liability even matter? Their job is to treat whoever comes through the doors of the hospital. Federal EMTALA laws protect a woman’s right to be treated in labor. ACOG supports patient autonomy even if the provider feels the woman’s choices are in conflict with the provider’s belief that her choices are unwise. A practitioner’s unprofessional behavior actually increases the provider’s liability by failing to respect patient autonomy and by refusing to provide the same level of care they would give to any other patient they serve.

This lack of professionalism experienced in the hospital sometimes extends beyond the birth. This is where I feel like the treatment is almost entirely punitive. While I can understand the frustration and stress of a provider who receives an in-labor hospital transfer, this type of post-birth discrimination seems like coercion and punishment for a family making choices that a provider does not personally support.

After a normal, healthy birth, the midwife’s scope of practice is normal newborn care throughout the first 6 weeks. The midwife conducts all of the usual assessments and then recommends the family see a pediatrician for a normal well baby visit at the end of the six-week period. The family calls to make an appointment.

Hold the phone! Wait a second, they won’t see the baby? Why not? Some practices won’t see the baby because the baby was born at home. Say what? They won’t see the baby for 6 months because they didn’t get the vitamin K shot? You’ve got to be kidding me!

Do physicians have the right to deny those people care because they disagree with their choices? For instance, is it OK for a pediatrician to refuse to accept a patient into care because the mother doesn’t breastfeed her baby? Would it be OK if a pediatrician refused care for families who homeschool? No, of course not. Yet, in many cases, with the population of families we serve, if a family has refused for their newborn anything from the mainstream model (such as a Vitamin K shot or erythromycin eye ointment or hepatitis B vaccine), they encounter judgment, fear, or a refusal of service.

It is unethical to refuse care in an attempt to coerce or bully a patient into consenting to care they have refused. It is unethical to refuse care as a way to punish families for their choice to give birth in a way that you do not agree with. It’s morally wrong.

The shame that is heaped on families who’ve chosen a path outside of the mainstream standards has created a culture of resistance and distrust, and that’s not good for anyone. Women and their families should be able to count on a multi-tiered model of care. If a woman plans to give birth at home and the labor takes a turn, she should be given a high quality of care during her transfer, and when she becomes a patient at a hospital. What if instead of shaming, a medical professional chose compassion? Understanding? And what if the medical professional were trained to see themselves as an important part of the picture for women who choose to birth at a birth center or at home?

The shaming has to stop. The punishment has to stop. Is it any wonder we don’t trust you? The distrust has been built on years of mistreatment. It rests on the shoulders of those in the medical community who lack professionalism, who don’t separate their own personal choices and/or training from the choices of the women and midwives who come to them in good faith and in order to see a labor to a successful and safe conclusion.

This dynamic needs to change. Show women that you can treat them with the same respect their midwives show them. Help women to make informed choices, and then respect their right to informed refusal (without trying to make them feel bad about the final decisions). Welcome us—the birth team and the laboring women—so we feel we can come to you for help when it’s needed. Welcome us, so we don’t feel like we want to wait a little longer to see if things get better because we’re scared of how we’ll be received when we arrive at the hospital. Welcome us, so we know we can share our stories fully and honestly with you, without fear of mocking or teasing—or retaliation against our clients.

If the goal is truly to provide good care and not to punish people whose views differ from your own, it’s time to do something to make a change for the good. Every time we interact with you, you have a golden opportunity to let the medical profession shine. Don’t blow it. Help us walk towards you instead of away from you.

If you’re a doctor or a nurse and you support families who make choices that aren’t in alignment with your protocols, this post is not about you. Or, maybe it is. Maybe this is a love story about you. You are the people who give me that glimmer of hope that change is possible and that midwives, consumers, and the medical community can work together to make outcomes better for mothers and babies, and make the experience better for all of us.