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.

Good Cheer and The Pregnancy Diet

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It’s that time of year. The time when we bake cookies and fudge and tasty pies. The time when the workplace break room is littered with holiday candy and plenty of chocolate. It’s a time when it feels almost obligatory to feed the sweet tooth. But what if you’re pregnant? Does pregnancy give you an eat-all-you-want pass with the holiday sweets? The short answer is no. But then again, as with most anything, it’s all about balance.

We as midwives make nutrition an important part of the care we offer pregnant clients. It’s the hallmark of good prenatal care. To help pregnant women navigate this holiday season, we asked a seasoned midwife/educator/author to share her tried and true pregnancy diet, a diet based on a modified American Diabetes Association (ADA) diet, with specific portion sizes and an accompanying chart. The best part? Desserts are not off-limit, although one piece of pie could blow a lot of the small, allowed portions.

Juliana Van Olphen-Fehr, CNM, PdD, retired director of the Shenandoah University nurse-midwifery program and author of Diary of a Midwife, spent an entire prenatal visit on nutrition when she had a combination home/hospital practice. Clients often joked that subsequent prenatal visits were diet confessionals; some tried to hide ice cream cones from her view when running into her outside of appointments. The nutrition prenatal session left its indelible mark on the pregnant women she served and the Fehr pregnancy diet was a hallmark of her successful practice.

Recently, we asked her if her opinion on the optimal pregnancy diet had changed all these years later: “No. Not one bit…. You are what you eat, so when you’re pregnant, so is the baby [what you eat]. What your job is, when you’re pregnant, is to nourish that body and really make sure that the body inside you will grow up to be an incredible and productive human being.”

Dr. Fehr frames the pregnancy diet in both biological and historical perspectives. Our brain requires glucose. “It doesn’t use protein and vitamins. Glucose is it. And now the pregnant woman has two brains and one is really changing fast. It’s growing and it’s interested in getting all the nutrition it needs.” Yet, historically, humans’ access to sugar was seasonal and typically fruit, or at the very least, lactose, another sugar, from a cow’s milk.

“Humans were designed to survive despite the lack of access to sugar. That’s what we were meant to do, because [historically] we didn’t have it. The problem is that evolution takes thousands of years to develop. We now have so much access to sugar; we are inundated with it. We need it. We crave it.”

But at some point the pancreas won’t keep up with a contemporary intake of sugar. And that creates problems for both the baby and the mother.

Every day a pregnant woman needs grains and carbohydrates to offer the brain the sugar it needs. But the trick is to keep track of serving sizes and amounts. A pregnant woman and her growing baby needs:

  • 9 servings of carbohydrates
  • 9 servings of protein
  • 3 servings of milk
  • 3 servings of vegetables
  • 6 servings of fruit
  • 5 servings of fat

And the serving sizes are small: 1 ounce of meet or cheese, 1 egg, or 2 tablespoons of nut butter meet the protein serving requirement. And nut butters also count for 2 of the fat exchanges. Vegetable serving sizes are ½ cup cooked or 1 cup raw. One half of a bagel, 1/3 cup cooked lentils, 1 small potato, or 2 cups cooked pasta meet the carbohydrate serving size requirement.

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So where does that leave a pregnant woman during the holidays? A little bit of good math, planning, and awareness go a long way. Enjoy that pie, but be mindful of the carb, dairy, fruit, and fat exchanges. Enjoy that piece of fudge, but pull back on your dairy and fat servings for the remainder of the day. And be sure to fill the rest of your day with all of the nutrients that are most important for you and your growing baby. You’re eating for two. Two brains, two pancreases, one of each that are still growing and developing. A good diet is an investment in your own health and in the long-term health of your baby. Cheers!

When a Home Birth Becomes a Hospital Birth

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You did everything “right.” You took Bradley Method childbirth classes. You hired a doula. You hired a midwife to attend your birth. Your diet has been perfect. You rented the birth pool. You took all of the right supplements, attended prenatal yoga classes, had regular chiropractic care, and gained a good amount of weight — not too much, not too little, just right for you.

But birth isn’t just a series of checklists.

It’s good to pay attention to what contributes to a healthy pregnancy and birth, but it’s not a guarantee that the actual birth will perform like an item on a checklist.

Birth is complicated, often messy and surprising, and it’s best to remain flexible as you approach the due date.

Despite doing everything “right,” for some reason, things might not go as planned, and the blissful, ecstatic, empowering, or even orgasmic home birth you planned becomes the birth you didn’t plan. Your home birth becomes a hospital birth.

Is this such a bad thing? It doesn’t have to be. It can be a very good experience, even if it deviates from the original plan. As a midwife, I’ve seen the good, the bad, and the downright ugly hospital transfers. Fortunately, the ugly transfer experiences have been rare.

The Different Paradigms of Care

Midwives and obstetricians approach birth from different paradigms. So what is a different paradigm of birth and why does it complicate things? For one, midwives are trained to attend the 95% of births that occur without complication. The approach to labor is grounded in this very real statistic, but also has to do with the midwife’s training, which focused on continuous labor support and limited intervention.

A physician and/or surgeon is trained to handle the 5% of complicated births. In contrast to midwifery training, obstetrical training is grounded in staying ready for that rarer complication.

It’s important to note that midwives are trained to recognize when a complication arises and vigilantly keep an eye on a woman’s labor to ascertain if there is ever a need to transfer care to a hospital, where a physician/surgeon can take over the birth.

Sometimes the two types of training can clash. Most often obstetricians have never attended a home birth or observed a birth with a midwife in the primary care role, whether at home or at a birth center. Thus, their only experience with home birth moms is likely the mom who has transferred with a complication. They don’t see the other, larger population of women who have had healthy births at home or in a birth center with the midwife.

In their training, obstetricians see the more complicated side of childbirth. One physician I know spent her obstetrical rotation at a hospital serving a poor community that had limited access to prenatal care. Some of the mothers were addicts. The deliveries were complicated and the outcomes not always optimal. While this training and awareness is necessary and important, especially in emergency situations, it can color their responses to home birth transfers. They have seen what poor prenatal care and poor lifestyle choices can mean for a birth. The part of midwifery care that they may not understand is that midwives have already carefully screened their clients to be sure that the pregnancies are healthy and that home birth or birth center birth is a viable option for the mom. It’s also not uncommon for a midwife to transfer care during the pregnancy if the mother becomes high risk.

In my case, as a member of my local healthcare community, I do my best to educate the hospital staff, nurses and physicians alike, as to how a midwife practices. It can be hard to cast aside a person’s training experiences to learn about a different model of care, but with hard work and respectful dialogue, between the moms and midwives and the hospital staff, care providers in the obstetrical care setting can gain greater understanding of just “who these midwives really are.”

So what will a transfer birth look like?

The ability to transfer a mother is an important tool in the midwife’s toolbox. And a transfer hospital birth can turn out just as positive as the home birth might have been.

Depending on the hospital and staff, a midwife may shift into more of a doula role during the birth, helping the laboring mom make the best decisions and making sense of the medical events that often happen quickly with a transfer. The midwife can provide support to the family members who might be there as well. Sometimes the hospital will require the midwife to leave, but that is becoming a rarer exception. If that happens, the midwife will still provide some sort of postpartum care and support. During the transfer, the nurses and doctors are doing their job when they take over the birth – they know complicated birth best – and it’s important to remain grateful for both models of care.

The goal of every birth is a healthy mom and baby. Stay focused on navigating the transition with a positive attitude; it will help you feel better after the birth, whether your birth is a home birth, or a transfer hospital birth. Assert your needs, but don’t be confrontational. Be respectful. A combative attitude helps nobody and serves as an obstacle to good care. Your midwife will be there to help you process the unexpected transfer and transition in care. Midwifery care does not stop with the transfer; it simply follows the needs of the mother, no matter the birth setting or interventions.

Disappointment is Natural

You know you did everything right: you followed the latest nutritional guidelines, you exercised, you took a childbirth class, you prepared. But your birth didn’t happen at home like you planned; it happened at the hospital. The important thing is to remain grateful that you could rely upon a two-tiered system of care. The right provider used his/her skills to bring the birth to the final stretch. Yet, you have an overwhelming sense of disappointment.

Birth is an emotional event. It’s physical, it’s spiritual, and it’s a hormonal journey that sometimes bring tears, elation, sadness, joy, or a combination of all. If you’re feeling disappointed about the birth, find ways to express that disappointment. Write about it. Talk about it. Cry about it. Practice radical acceptance.

Your birth is just one step in the path into motherhood. Celebrate that you’ve become a mother and focus on the positive. Your birth happened just as it needed to happen.

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.

Gratitude

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Gratitude is the fairest blossom, which springs from the soul – Henry Ward Beecher.

The old adage, “Avoid politics at family gatherings,” is particularly prescient for the 2016 Thanksgiving holiday. Some have family members who enjoy political arguments or the ability to get a rise out of those who hold different beliefs. But if this political season has taught us one thing, it’s the importance of civility, respect, and graciousness.

Don’t take the bait.

The Thanksgiving table may not be the place to convert hearts or minds. Make a choice instead to focus on the history of the holiday. At the heart of the historical day is a story of survival, friendship, and the setting aside of differences to break bread at one table. The literal history of the first Thanksgiving continues to be debated by historians, but most Americans can agree that the holiday each November is a time when we come together to remember the hardship of the early Americans settlers and the Wampanoag tribe who shared their wisdom and skills. Without the help of the indigenous peoples of America, the settlers would have starved.

Our modern tables are often filled with rich desserts, casseroles, and farmed turkeys. The settlers’ table was likely set with a lean venison and goose or fish, nuts, and stewed fruits, cornbread and squash. There wouldn’t have been flour for pies, nor sugar to sweeten desserts. I wonder—were they able to communicate? Did a settler or Native American serve as translator? Was there more silence than conversation as they sat at one table to share the harvest?

I try to imagine what it felt like to be so far from an ancestral home, hungry, hope fueling the courageous act of sailing across a giant ocean to find religious freedom and peace—what it felt like to see strangers arriving on the shores of ancestral lands. I imagine that what guided their hands as they baked cornbread over a fire, turned a wild turkey on a spit, or buried squash in the embers, was thankfulness. Their stomachs would be full that day; their children would not be hungry. Because of the friendships forged across language and cultural barriers, they spooned gratitude along with the stewed apples and chestnuts. It was a delicate thing, this gratitude – something that sprouted from new experiences, vulnerability, and interdependence. I would imagine there was even fear sitting between the indigenous people and the new settlers. But break bread they did.

This year, when the country is feeling more divided than ever, it’s imperative to strip Thanksgiving dinner down to its barest, naked element. To remember the simplicity of that first Thanksgiving meal. Navigating a political discussion may mean simply stepping away from the lure of a heated discussion, setting aside personal fears or judgment in order to focus instead on the central tenet of the holiday: thankfulness. Consider these wise words from Dalai Lama XIV:

Every day, think as you wake up, today I am fortunate to be alive, I have a precious human life, I am not going to waste it. I am going to use all my energies to develop myself, to expand my heart out to others; to achieve enlightenment for the benefit of all beings. I am going to have kind thoughts towards others, I am not going to get angry or think badly about others. I am going to benefit others as much as I can.

Focus instead on the new recipients of the Presidential Medal of Freedom. On the inspirational words of Michele Obama, “…Our motto is, when they go low, we go high.” Focus instead on the food that fills the table. On the plump, roasted turkey; on the warm cornbread or rolls; on the ease with which so many are now able to fill the table. Remember the gratitude the settlers served with stewed apples and roasted chestnuts. Each time you pass a dish or offer a serving of food to a relative, focus on the Latin root of the word gratitude, gratus, pleasing or thankful. Set aside worries and tensions, and steer conversation to topics that expand the heart and bring your family together. Remember the interconnectedness of the people who didn’t share a common language, but broke bread together. Because sometimes, breaking bread is the most important thing we can do.

Official 1864 proclamation by President Abraham Lincoln