Common Pregnancy Related Discomforts – Nausea and Vomiting

General Description

Nausea is an unpleasant feeling of queasiness and an urge to vomit. Vomiting is the expulsion of the stomach contents through the mouth as a result of involuntary muscle spasms. Experienced by more than 80% of women as a sign of pregnancy, the onset of nausea occurs between 5 – 7 weeks gestation, peaking around 11 weeks, and typically resolves by 14–16 weeks. Severe cases of vomiting past 20 weeks may be hyperemesis gravidarum.

 

Sources of Discomfort

Inadequate dietary adjustments to pregnancy, keeping the stomach empty for prolonged periods of time, and low blood sugar (hypoglycemia), and also a response to increased and rapidly rising hormone levels in early pregnancy (estrogen, HCG).

 

Methods of Relief

Morning Discomfort

  1. Eat high protein snack before bed, and at each waking
  2. Eat before rising – cracks or toast. Protein is ideal, if tolerable. Rise slowly upon waking.
  3. Diclegis: 2 Tablets at bedtime

 

Throughout the Day Discomfort

  1. Eat small, frequent, high-protein and vitamin B rich meals every 2 – 3 hours, Carry snacks with you on-the-go, and avoid dehydration, and sip small amounts.
  2. Avoid triggers such as strong odors, spicy / fatty foods, fatigue, heat, and stuffy rooms.
  3. Acupressure wrist bands.
  4. Drink water at room temperature and sip through a straw when even water is difficult to consume.

 

Herbs & Supplements

  1. Take vitamin and mineral supplements AFTER meals
  2. Vitamin B6: 25 mg 3-4 times daily, or 50 mg twice daily
  3. Teas: chamomile, red raspberry leaf, peach leaf, basil, spearmint, peppermint, and ginger
  4. Sucking on hard candies – ginger, peppermint

 

Immense Morning Sickness

  1. Unisome & B6 at bedtime

 

Additional Reading & Helpful Tips

12 Ways to Naturally Ease Through Morning Sickness and Find Comfort and Health Through Hyperemesis Gravidarum

Common Pregnancy Related Discomforts – Leg Cramps

General Description

Cramps or spasms in the muscles of the legs. They are common in pregnancy, especially at night, and can interfere with the ability to sleep. “Charley Horse” is a cramp that is typically a sign of calcium and magnesium deficiency.

 

Sources of Discomfort

Often due to nutrient imbalances, dehydration, overexertion, and pressure on the pelvic blood vessels or nerves impairing circulation to the lower extremities due to uterine growth.

 

Methods of Relief

Positional Relief

  1. Gentle stretching of leg muscles – toes flexed upwards, walking daily to promote circulation, shifting weight from one leg to the other when standing, and avoiding sitting with legs crossed.
  2. Elevation of the legs above the heart throughout the day, and counter pressure on the bottom of feet when laying down (partner hand / footboard of bed).

 

Pampering

  1. Enjoy a hot bath before bed, and keep legs warm while sleeping (warming pad). Can add magnesium flakes / Epsom salt to bath water.

 

Diet, Supplementation & Herbs

  1. Adequate diet to include bananas, grapefruit, oranges, milk, cheese, cottage cheese, yogurt, salmon, sardines, dark greens, seaweed, soybeans, almonds, sesame seeds, oils, and essential fatty acids
  2. Adequate sodium (1500 mg), calcium (1000 mg), and potassium (4700 mg), daily
  3. 350 mg of magnesium at bedtime
  4. Raspberry leaf, nettle, dandelion, crampbark teas and tinctures

Common Pregnancy Related Discomforts – Hemorrhoids

General Description

Hemorrhoids are dilated veins (varicosities) in the lower rectum which are common during pregnancy. They can be internal (inside the anal canal) or external (at the anal opening) with symptoms include rectal irritation, burning, itching, swelling, pain, and bleeding.

 

Sources of Discomfort

Normal changes in hormones, and pressure from uterine weight as baby grows, play a role in the dilation and prolapse of the vessels. Hemorrhoids can be aggravated by straining during bowel movements, low-fiber diets, recurrent constipation or diarrhea and regular use of iron supplements, stool softeners, and enemas. Hemorrhoids are also common after pushing during childbirth. Causes of the discomfort.

 

Methods of Relief

  1. Avoid standing, sitting (include commode) for prolonged periods of time. Lay on your left side during rest periods.
  2. Avoid inflated “donut” pillows, which compromise circulatory drainage.
  3. Regular activity and occasional Kegel exercises may be helpful.
  4. Use of a stool (squat pot) to bring feet to toilet level for better muscle alignment and less rectal strain during movements.
  5. Increase dietary fiber and hydration levels.
Compresses & Bath Soaks

  1. Hot / cold: Include – Witch hazel, comfrey, epsom salt, sitz, red clove

and nettle

  1. Grated (as a compress) or thinly sliced raw potato (as a suppository)

to shrink and relieve swelling

 

Topical Application

  1. Plantain, yarrow, and goldenrod ointments
  2. Vitamin E capsule, as a suppository, 400 IU or more
  3. Aloe Vera gel
  4. Lubricate hemorrhoid with olive oil and gently push back into the rectum
 Herbal Suppository for Hemorrhoids

 

4 oz cocoa butter

2 oz each powder – marshmallow root

– white oak bark

– goldenseal

2 oz calendula oil

Refrigerate in suppository mold

Insert every evening

Wear a pad to absorb leakage

Knee-chest position to promote drainage

 

Tinctures, Teas, Tablets & Homeopathy

  1. Yellow Dock root tincture: ½ dropperful orally, 3x daily
  2. Bilberry tablets, 3x daily
  3. Horse chestnut, in any form
  4. Hamamelis (oral form of witch hazel) during hemorrhoid flares, 30c as needed

Common Pregnancy Related Discomforts – Heartburn

General Description

Heartburn is an internal burning sensation in the chest or throat as a result of regurgitation, or reflux of acidic gastric contents into the lower esophagus. As many as 80% of women experience heartburn in the third trimester of pregnancy.

 

Sources of Discomfort

Pregnant women are more prone to experience heartburn due to physiologic changes during pregnancy, such as stomach displacement as the baby grows, the softening of the lower esophageal sphincter from increased progesterone in the body, and decreased motility of the GI tract. Heartburn can be triggered by eating rapidly, or consuming foods that are fatty, spicy, or fried, as well as by consumption of citrus, coffee, chocolate, or alcohol.

 

Methods of Relief

  1. Consume small frequent meals, avoiding specific food triggers. Consume liquids separate from meals to inhibit secretion of gastric juices. Avoiding laying down for one hour after meals. Consider taking a walk to remain upright and encourage digestion.
  2. For night occurrences, sleep semi-upright with the use of extra pillows.
  3. Avoid antacids (tums / Mylanta), Alka-Seltzer, and baking soda.
  4. Digestive and/or papaya enzymes with meals.
  5. Comfrey tablets with pepsin.
  6. A plain baked potatoes and thoroughly chewed raw nuts, particularly almonds.
  7. 1 Tbs of cream or milk to coat the stomach.
  8. Acupressure Points: Applied to stomach 36 and Pericardium 6.
  9. NF formula’s liquid calcium/magnesium supplement, 1 tsp. to 1 Tbsp., as needed.

 

Lozenges, teas, and infusions

Slippery Elm, marshmallow root, ginger, peppermint, chamomile, skullcap, or passion flower

Common Pregnancy Related Discomforts – Headaches

General Description

Pain associated with headaches can be felt in the front or back of the head, behind the eyes, on the sides, or engulf the entire  head area. Headaches can come in the form of tension, migraine, and present chronically on a daily basis. They can also be accompanied by nausea, vomiting, light and noise sensitivity, dizziness, and visual disturbances.

 

Sources of Discomfort

Common headaches are typically caused by dehydration, lack of timely nourishment (hypoglycemia), sinus and allergy issues, hormone and circulation changes, or eyes strain due normal fluid retention during pregnancy. Low iron can also play a role, as oxygen availability within the brain is reduced.

 

Other triggers:

–    Being in the presence of smoke or strong odors, the body becoming overheated,

sleep deprivation, and caffeine withdrawal. Migraines may appear for both genetic

predispositions and environmental exposure.

 

Methods of Relief

Prevention

  1. Avoid exposure to environmental toxins, caffeine, and limit sugar in-take.
  2. Remain well hydrated, consuming small, frequent meals every two to three hours which

include adequate amounts of protein (80 g daily) and salt (1500 mg daily) which helps

with water absorption.

  1. Balanced amount of rest and physical activity. Promoting moments of relaxation

through yoga, meditation, chiropractic adjustment, acupuncture, massage, or

hydrotherapy.

 

Supplementation

  1. Magnesium: 600 mg orally once daily –   Coenzyme Q: 150 mg orally once daily   –   Riboflavin: 400 mg orally once daily
  2. Butterbur root extract (Petadolex): 75 mg orally twice daily

 

Remedies When Headaches Present

  1. Sleep, in a quiet and dark place
  2. Relaxing teas such as hops, skullcap, and chamomile, as well as a warm lavender-infused rice bag applied to the neck.
  3. Simultaneously soaking the hands in hot lemon water

 

Over the Counter Options

  1. Aspirin: between 250 – 1000 mg orally, not to exceed 1500 mg daily
  2. Ibuprofen: 200-800 mg orally every 4 hours, not to exceed 3200 mg daily
  3. Acetaminophen: 1,000 mg orally

 

Persistent headaches should be brought to the attention of your care provider immediately, as it can be a sign of an underlying and more serious issue.

Common Pregnancy Related Discomforts – Constipation

General Description

Infrequent, often painful, bowel movements, followed by straining and presentation of hard stools.

Sources of Discomfort

During pregnancy, bowel motility is decreased. This lingering of stool in the GI tract, causes an increase in water reabsorption within the intestines. Pressure from the enlarged uterus can also contribute to constipation. Excess iron supplementation, lack of dietary fiber, over-use and mis-use of laxatives (reducing that body’s ability to recognize release cues), dehydration, limited physical activity, stress / anxiety, and depression.

Methods of Relief

  1. Sufficient water in-take, at 80 – 128 fluid ounces, daily. Drinking a hot liquid (herbal teas), followed immediately by a cold liquid can encourage bowel movement. Vegetable and fruit juices (prune) can also be helpful.
  2. Increase fiber in diet: dried fruits, such as prunes or apricots, chia seeds, flax seeds, whole grains, vegetables, papaya, nuts and seeds. Ensure carbohydrates are unrefined. Consider a change in daily vitamin supplements.
  3. Ensure iron supplement is not “ferrous sulfate” derived. Yellow dock can replace “ferrous sulfate” iron supplementation.
  4. Eat less red meat, especially smoked and cured meat such as bacon, ham, sausage, and pastrami.
  5. Regular physical activity encourage movement within the bowels. Avoiding holding, or straining to release a movement.
  6. Avoid antacids, cathartics, enemas, and over-use of laxatives.
  7. Magnesium Powder – 1 – 2 tbs. in warm water before bed.

Helpful stool softeners (temporary use only):

  • Docusate sodium: 50 mg 1 – 2 times daily
  • Docusate calcium: 240 mg 1 time daily

 

  1. Fiber Therapy:
  • Citrucel or Metamucil: 1 T in 8 oz fluid, 1-3 times PO Daily
  • Psyllium capsules: 1-2 PO daily
  1. Herbal Support:
  • Senna, nettle, and violet leaf teas

Common Pregnancy Related Discomforts – Backache

General Description

Pain, discomfort, or achiness of the back region, is experienced by approximately 70% of women during pregnancy. Posture, body mechanics, and muscle tone, along with a variety of factors can contribute to back pain.

 

Sources of Discomfort

During pregnancy, necessary hormones cause the softening of joints and ligaments in preparation for birth. The weight of a healthy growing baby can cause a shift in posture to accommodate the ever changing center of gravity, and may lead to misalignment or tilt of the uterus. These changes will often causes nerve and muscle pain, as well as stress to the ligaments which attach to the uterus and sacrum, resulting in upper and lower back pain.

 

Other potential source(s) of backache:

  • Kidney Infection – when pain / discomfort is at waist level

 

Methods of Relief

  1. Avoid excessive bending, lifting, or walking without appropriate rest periods. Wear shoes that are flat and comfortable, avoiding heels.
  2. Proper stooping / bending position, with feet shoulder width apart, one foot slightly in front of the other. Use a squat when lifting, rather than bending at the waist.
  3. Use of proper back support (brace, belt, maternity girdle, abdominal support) when sitting or standing for excessive periods of time.
  4. Sleeping surface should provide good support. Make use of body and pregnancy pillows, ensuring a pillow at the back and between the legs to keep knees hip width apart.
  5. Physical activity that provides gentle stretching such as yoga and swimming. Pelvic tilts and rocking can be particularly helpful in easing discomfort.
  6. Chiropractic Care and osteopathic therapy. As well as massage, acupuncture, and acupressure. Pamper yourself during this time.
  7. Use of heat / cold in the form of baths, water bottles, or packs. Magnesium flakes / Epsom salt added to baths can also be helpful. 1-2 cups in a large tub. Apple Cider Vinegar soaks, castor oil packs, and capsaicin cream can also bring relief.
  8. Increase your daily intake of calcium and magnesium, either through nutrient rich foods, such as dairy, dark leafy greens, and nuts, or through supplementation.
  9. Many herbal therapies can also be helpful, as needed:
  • Devil’s Claw: 50 – 100 mg daily
  • Willow Bark: 120 – 140 mg daily
  • John’s Wort Tincture: 15 – 25 drops in a glass of water, every few hours, as needed
  • Cayenne: used as a poultice or a plaster over the area of discomfort

15 Ways to Naturally Treat Pregnancy Related Gas and Bloating

Gas and bloating – It’s one of those pregnancy related “ailments” that can be embarrassing and uncomfortable to not only deal with, but also to talk about.

 

The Role of Pregnancy Hormones
As early as the first trimester, pregnancy hormones such as progesterone slow the processing of digestion to ensure proper nutrient absorption for your baby. This “slowing down” process often results in the food remaining within the intestinal tract for longer lengths of time, producing more gas than is typically normal for your body outside of pregnancy.

Pregnancy hormones also work to relax your muscles in preparation for labor and delivery. This relaxation process can result in difficulties restraining from passing gas, and can happen before you even realized the urge was upon you.

These hormonal problems are compounded as the abdominal organs are crowded out as the uterus grows.

 

Bottom Line
There are many natural methods of helping this process along, and reducing the gassy and bloated sensations.

1. Increase Water Intake

The body is designed to store water reserves in preparation for labor and birth. The more water you in-take daily, the less water the body will need to store. This means less bloating and swelling as the end of pregnancy approaches. It also means less constipation, gas, bloating, and more regular and comfortable bowel movements.

Your body will replace the amniotic fluid surrounding your baby every 3 hours. Adequate water in-take for baby means clean fluid, and plenty of floating room to properly engage within the pelvis. It also keeps the uterus healthy and reduces the risk of infection during and after pregnancy.

The aim in pregnancy, ideally, is 80 – 128 fluid ounces daily. Yes, you read that right! You are aiming for a gallon a day. Of course, everyone is unique. This is the reason for the range. Some are fully hydrated at 80 oz. and others are 3 – 4 cups from fully hydrated at 80 oz.

Drink in small and regular intervals throughout the during the day. Below are some helpful tips to make it easier to in the amount of water your body and your baby need on a daily basis.

  • Drink in intervals throughout the day.
  • Often, room temperature water is easier to consume in large quantities.
  • Drink from a glass without using a straw to ensure you avoid sucking in excess air.
  • Straws are helpful when still dealing with pregnancy related nausea.
  • Minimize your consumption of carbonated drinks to avoid ingesting gas bubbles. (carbonated drinks can also contribute to dehydration)
  • Fresh fruit juices also help in removing toxins from the body and prevent bloating.
  • Non-diuretic herbal teas count as water in-take!
  • Keep a water glass in different locations, as you can be reminded often to drink.
  • Attempt to drink 5 swallows of water after every bathroom visit.

 

2. What You Put Into Your Body Matters

 Different foods can be triggers for different people. Common gas-causing foods such as dairy products (milk, cheese), beans, peas, whole grains – gluten, cauliflower, cabbage, broccoli, asparagus, and onions – to name a few, can be eliminated or significantly reduced if you feel they may be contributing to gas and bloating.
Dairy is one of the top contributors to gastrointestinal issues in the majority of the population. Many pregnant and nursing women find themselves needing to cut dairy from their diets. Newborns, themselves, are not born with the enzymes necessary to break down the proteins found in dairy products – the ability to break down these proteins is achieved once they have reached 12 – 13 pounds.
Avoid teratogens in pregnancy is vitally important to the healthy formation and development of a baby in the embryonic stage. A diet which consists of nutrient dense whole organic (free of pesticides) foods, and avoids GMO (genetically modified), processed, boxed, and frozen options means the best start towards a healthy pregnancy and baby.  These changes will also reduce the likelihood of indigestion and flatulence in the most natural way.
Helpful Tips:
  • Active culture dairy products, such as yogurt or kefir, aid in digestion.
  • Avoid consuming fried or fatty foods.
  • Avoid artificial sweeteners. 
  • Avoid intestinal toxins such as MSG (monosodium glutamate) and HFCS (high fructose corn syrup).
  • Consider adding fermented foods such as kimchee or sauerkraut to your diet. Kombucha is also helpful.
  • Soak grains and beans overnight and change the soaking water a few times to help “de-gas” them. Adding acidity to the water can also help (lemon juice or ACV).
  • Some women need to reduce gluten, which can cause swelling of the intestinal walls.

Keep in mind that you won’t want to eliminate all gas-causing foods from your diet. Consuming adequate fiber and a variety of nutrient-rich foods is vital during pregnancy and helps in the prevention of constipation and hemorrhoids – which are other common pregnancy discomforts. Being self-aware of which foods cause the greatest problems can help in meal planning and outings.

3. How You Put Calories Into Your Body Matters

Smaller, more frequent meals
While you need to consume additional calories during pregnancy, the hormones which result in a slower digestive system also means that less food needs to be in the intestinal tract at one time. Smaller, more frequent meals will help ensure the digestive system does not become overloaded, leading to gas, bloating, and constipation. This means not getting stuck in the 3 meals a day regiment. Have a light (small) meal, then a snack, and another light meal, and a snack, and repeat continuously, every 2 – 3 hours, through the day.

Eat slowly and thoroughly chew your food
The majority of gas within the digestive system is produced when bacteria in the large intestine is tasked with breaking down food that has not been thoroughly digested by the enzymes in the mouth or stomach. Breaking down food by taking the time to properly chew will lessen the load on the intestinal bacteria and reduce gas production. Take your time, and enjoy and savor the taste of your food.

 

4. Eliminate Consumption of Refined Sugars

  • Every time you crave “sugar” eat protein instead!
  • Avoid Fructose, often found in artificially flavored juices.
  • Avoid chewing gums and lozenges which contain sorbitol.
  • Taking a probiotic 3x week (don’t over use), to help ensure healthy gut flora.
  • Candida (yeast) thrives on sugar, and is often the culprit in “sweet tooth cravings.”
  • Essential Oils Lemon, Melaleuca, and Oregano help kill off candida within the body (medicinal grade – after the first trimester).

5. Baked Not Fried

Remember, the intestinal tract is moving slower during pregnancy. Foods that may not typically “release gas” into the body, can cause bloating when sitting in the digestive tract for an extended period of time. Even simple foods such as fries and chips can leave behind a “fried” sensation in the gut. These foods also counteract the growth of healthy intestinal bacteria.

 

6. Consume Foods Rich In Fiber

Finding the perfect balance of reducing gaseous foods, and maintaining adequate fiber in-take can be a tedious task at first.

Getting in 25 to 30 grams of fiber daily is ideal to maintain good bowel health, and avoid constipation. A diet high in nutrient dense whole foods can change everything about how you feel physically and mentally throughout the day.

 

7. Fenugreek Seeds

The consumption of fenugreek seeds has been a tried and tested solution to control gas trouble during pregnancy. You can take a tablespoon of fenugreek seeds and soak it in water overnight. Filter the seeds from the water and drink the water to reduce flatulence.

 

8. Lemon Juice

Squeezing a whole lemon into a bowl, adding one cup of water and half a teaspoon of baking soda. Stir until the baking soda is completely dissolved. This can bring complete relief for intense gastric issues.

Drinking warmed lemon water first thing in the morning can also relieve morning intestinal pain and bloating.

 

9. Herbal Teas

Herbs are one of the most trusted and reached for home remedies. During pregnancy, herbs such as mint, blackberry, raspberry, fennel, and chamomile are known to aid in the digestive process.

While herbal teas can be enjoyed hot or cold, drinking at least one cup warm daily, significantly helps the digestive system in functioning properly, and preventing constipation. Even better is drinking a cup warm each morning, and before bed.

 

10. Peppermint

Peppermint has long been used as a natural remedy for gas, nausea, and indigestion. Either in the form of an herbal tea, an essential oil, or a capsule. For capsules, ensure that they are enteric coated (pass through the stomach and into the intestines before dissolving), so that you get the peppermint to the location where it is needed the most.

11. Coriander

Consumed raw, or added to cooking meals, coriander helps the digestion process. Coriander leaves are also great for acidity and burning sensation in the stomach. Adding roasted coriander to a glass of buttermilk is useful to keep indigestion and gas at bay.

12. Drumsticks (moringa)

This fibrous food is a necessary addition to your meal especially if you are suffering from hard stools. Since the bowel movements are irregular, there are chances of excess gas formation in your body. It will increase roughage content in your food and will improve stomach health to a great extent.

 

13. Magnesium

This natural stool softener can help in countering some of the negative effects caused by the slowing of the digestive system during pregnancy – keeping things naturally moving along, and comfortable. This also means that gas and bloating don’t build up.

Finding the best quality magnesium, and the right derivative are important to meeting the body’s individuals needs. Find the best magnesium supplement.

 

14. Yoga and Exercise

Exercise helps stimulate digestion. This means your food will move through your intestinal tract more quickly — and produce less gas along the way.

Yoga, swimming, and walking are great forms of physical activity that allow for modifications that prevent over-exertion of the body during pregnancy, but also encourage the body systems to move and function.

A brisk walk each day is a good habit that addresses several common pregnancy discomforts. Swimming is also helpful and brings great relief from gravity during the third trimester. There are also three yoga poses which are known to help with gas. All three are done on-all-fours:

  • The pelvic rock or “cat” position involves arching your pelvis up like a cat, then gently dropping it down to make a hollow in the small of your back.
  • The side-to-side or pelvic “rock” position involves arching sideways to the right, bringing your head and rear end close together, then gently arching yourself sideways to the left — just like you’re wagging your “tail.”
  • The circular rock position involves rolling your pelvis around as if you were belly dancing, but while on all fours.

 

15. Wear Loose Clothing

Tight clothing around your waist can further constrict a digestive system that is already being crowded by a healthy growing uterus. Nothing should be digging into the skin, leaving marks or indents, as this cuts off circulation, increases edema, and deters movement through the digestive tract.

 

Shopping for a Doula? Here are 6 Steps for Navigating and Maximizing Your Doula Experience

Considering Hiring a Doula?

Image © and used with permission

Do you need to find a doula? Maybe you are hearing the word ‘Doula’ for the first time, or have heard it, but are very unfamiliar with a doula’s role or why it is so important to have a doula as part of your birth team.

A doula (a woman standing by) is a labor support person who provides physical, emotional and informational support for families throughout their pregnancy, birth, and postpartum journeys.

Doula care is so much more than just support during your labor and as a first time mom, or a family considering doula care for the first time, it can be a bit difficult to know where to begin in your efforts of finding the right doula for your family’s individual needs, but also maximizing the care-to-cost-to-connection ratio with the doula you choose.

Here are six steps to help you navigate this new territory and maximize the kind of experience you can have in your search to find a doula, but also in your birth journey!

Step 1: Do you even want or need a doula?

Find a doula!? Doulas are hired for all different birth scenarios, and not just an un-medicated, out-of-hospital birth. They are beneficial in any setting and are a perfect compliment to the care provided by a midwife, the continuous support needed in the hospital room, or the calming presence often missing in the surgical room. READ HERE for more information on the differences between a midwife and a doula.

Doing a simple search online for “local doulas” or “find a doula near me” can be a bit overwhelming, depending on where you live! Knowing what kind of services are generally available from a doula, and matching that with what your ideal vision is for your birth, can help you gauge, not only whether you actually want / need a doula, but what services you would like for her to offer. Then you can narrow down your doula search right from the get go!

The advantage to finding doulas in your area who offer the services you are looking for means you don’t have to hire three different individuals for services which could have been available all in one place. Hiring several people for different services adds more people to your contact loop before / after giving birth, which can honestly become a headache during a time when you are simply wanting to snuggle in with your new baby, bond AND sleep! This also creates fluidity and connection throughout your pregnancy, during birth, and into the postpartum period in your relationship with your Doula. They will be able to handle everything while you just focus on your new baby and your growing family!

Generally, doulas provide care in many different areas and also offer an array of additional services which are cohesive to doula care and the support of families. Not all of them of course, which is why it is important to find a doula that offers services specifically to meet your wants and needs. Determining which services are, or might be, important to you, and then searching doulas in your area who offer those specific services can save a lot of time in the interviewing process of finding the right one!

Here is a handful (or two ;-)) of potential service options available to doula families…

  • Informational support throughout pregnancy
  • Antepartum care (need support while on bed rest?)
  • Education on all of the options and decisions to be made from the start of labor to immediately postpartum for both the mother and the baby.
  • Birth plan preparation & guidance
  • Natural childbirth education classes
  • Breastfeeding education, classes, and counseling / support
  • Placenta encapsulation (tincture, mother broth, smoothies, prints, cord keepsakes)
  • Lending library (guidance on book recommendations based on your needs, and then the ability to borrow those books!)
  • Continuous birth support at home, then the hospital or birth center (inclusion of partner, or in place of partner)
  • Advocacy of your birth plan (so you and your partner can focus on laboring)
  • Capturing occasional photo moments (usually non-professional) P.S. there are professional birth photographers!
  • Postpartum care (need support after bringing baby home?) Why is a postpartum doula important for every mother?
  • Extended care packages – (informational support through baby’s first year!)

Step 2: If so, what is most important about her?

This can sometimes be a difficult question, especially for first time momma’s who really don’t know what their specific needs of a doula may be. I mean, how do you know what you will need from a support person while in labor, when you haven’t experienced labor yet!?

I’ve broken it down into a couple of sections to help you navigate how to answer this question for yourself.

  • Consider your love language
    • Considering your own love language can be helpful in determining, not only the character qualities you are looking for in a doula, but also, the kind of connection you will want to have developed with her before your labor. It is important to know whether she is experienced enough to know how and when to change gears with you, as your labor progresses, and have discernment in when to draw into you for support, and when to draw back and allow you space to find your strength and power.
  • Consider your partner
    • Birth is not just about the laboring woman. All too often, partners end up feeling like the “third wheel,” with the primary focus on the mother and baby. But partners need support too, whether they want to be hands-on in the birth process or not. All couples function as one in a very different rhythm. This means that some partners will want to dive right in and be as much of a supportive part of the action as they can be, or maybe even catch their baby! Others want the freedom to hang back and draw in as they feel comfortable in each moment. Then you have partners who would rather be more of an outside observer (or maybe the birthing mother would rather her partner be an outside observer), if even present within the birth space at all. Knowing how the doula will support your partner in each of these differing scenarios is important to knowing the full extent of her experience and how well she will support your family dynamic and the needs of your partner through each stage of labor.

                   Dads are having a baby too! Many dads come out of their birth experiences feeling:

    • Traumatized, having had no one to communicate with them in terms they could understand (getting away from medical terminology).
    • Scared, having had no one to keep their internal thermostat in check and assured that everything is safe and normal
    • Helpless, not having anyone there to guide them in ways they can help bring comfort and relief to the woman they love.
    • Lack of Joy, as they watched the scene unfold around them, as they tried to protect, be understanding, advocate for the birth plan, process recommendations and make fast decisions. Dads are missing out on the joy of watching and participating in the births of their babies… This is not okay. You can read more about how doulas are for dads too, and how together, they make up the perfect birth team! Dads and Doulas Find a doula for the expecting father, just as much for the expecting mother.
  • Consider the doula’s energy
    • The heart of doula care is in the connection, and the energy of that connection. You are bringing another energy into your sacred space of birth, and that energy should be welcoming of the unfolding process of birth. You should feel safe and comfortable with her and should feel confident that the advocacy she will provide represents your birth plan, and not her own.
  • Consider the doula’s experience
    • There is simply no price that can be placed on experience in this field. Of course, every good and experienced doula had to start somewhere. The wisdom that comes from their experiences can be a huge benefit to your family in navigating every faucet of this adventure. From the pros and cons of each hospital / birth center within the realm of your birth vision, to recommendations on which care provider / midwife will connect with your family dynamic and be supportive of your wants and desires for your birth experience. In many ways, your experience can be the best reflection of her experiences, as she guides you through medical field protocol. And let’s not forget how important her experience will be to you and your partner once in the throes of labor. What touch will bring relief in this moment? Which essential oil can be emotionally uplifting? Which rebozo technique can get rid of that pesky back labor (or what even is a ‘rebozo’!?)? The list really does go on here.
  • Consider the doula’s character
    • Client testimonials should play a crucial role in defining her real character and the passion she has for her profession and the families she is called into the service of. It is okay to request testimonials, and even ask to speak with a few previous clients about their experiences. Most doulas will know right away who would be willing to speak with you and share about that personal experience receiving their support. Ensuring that she is reliable, trustworthy, knowledgeable, but also, that working in this field is not just a “job” to them! All professions become “businesses / jobs” at some point. I mean we all have to make a living to support our families. But, that doesn’t mean that a business / job can’t still be full of heart! If the philosophy is “it’s nothing personal, it’s just business,” then the heart of this profession, for that doula, has been misplaced.
    • Also, consulting with your chosen care provider on whether they have had any experience working with your Doula. Was it a positive experience and would they welcome their presence back into the labor and delivery room?

Step 3: Know what you’re paying for! 

When first searching to find a doula, they are often compared first by their rates. This is a great disservice to the doulas being compared, as well as to the families seeking care. The doula who charges $1000 (20+ years’ experience), and the doula who charges $350 (who just finished a weekend training workshop and has completed the three free births she is supposed to attend to receive her certification), should not be compared by their rates. They should be compared by what the family’s needs are for their pregnancy and birth journey, and how the doula can meet those needs to the best of their ability. The rate has nothing to do with their compatibility to the family seeking care. Hey, every doula has to start somewhere to earn the “experienced” title. While cost and experience are important, they may not be as important as the connection you share once it comes time for your birth.

Also, be mindful that the rate the doula is charging does reflect her level of experience. If the average experienced doula rate in your area is between $800 – $1000, a new doula, with less than 10 births in her experience bag, shouldn’t yet be charging between that average bracket.

Be kind, and don’t schedule an interview, on the doula’s time, unless you are willing to work out a way to pay for her services. Show your potential doula that you value her time, her profession, the services she offers, her experience, and the benefits she can bring to your pregnancy and birth journey. Most doulas who are in this profession for the heart of it are willing to work with expectant families on payment plans to ensure that every family, regardless of circumstance, can receive the care and support they need, while also establishing a mutual agreement assuring that the doula herself is compensated for her invaluable time and support. If hired early in the pregnancy, a family can have 6 months or more, depending on arrangements made with the doula, to pay for the services. Hiring earlier is often better, and also offers more time for connection and more opportunities for your doula to provide pregnancy and informational support.

I have often heard that having a doula is a “luxury”… which is such an unfathomable concept to me. When did we get so far out of reach with what the act of giving birth really is, that having a person support the mother through the most challenging experience of her life is considered a “luxury” ??? Shouldn’t it be “common place” to expect her to be supported in the best way possible? Isn’t she deserving of that? Shouldn’t she be a able to find a doula to meet all of her unique and individual needs? Isn’t her partner deserving of enjoying the birth process, rather than having to stand there terrified and feeling helpless? How do we even get to a place where we can put a price or a value on something this important?

Dr. John H. Kennell has been quoted, “If a doula were a drug, it would be unethical not to use it.”

Doulas are not a “Luxury.” Doulas are a “Necessity.” Find a doula who makes you feel as valuable to her, as she will be to you.

For a generalized breakdown of what a doula really makes after expenses such as gas, food, taxes, supplies, childcare, etc., you can check out this article, A Breakdown of a Doula’s Fees and Why Doula’s Charge What They Do.

Step 4: Trust her to teach you

Over the years it has become apparent that the value in taking a childbirth preparation course has been forgotten. Birth is a joyous rite of passage that a woman takes. It’s a transforming journey from maiden to mother. Taking a course which provides knowledge on the anatomy and stages of birth, preparing the mind-body-spirit for the journey ahead, options & decision, natural coping techniques, and partner engaging (just to name a few…),  reduces the fear surrounding birth in our society today and builds confidence in a woman’s ability and power to give birth, and also achieve the joy and satisfaction that can be found in the hard work that it takes to bring forth new life.

We wouldn’t set out on a voyage around the world by boat without first taking some courses on what to expect on the open waters, how to navigate the boat, what to do during a storm, and know what supplies you may need and recognize how and when to use them. Birth is the greatest and most incredible and unpredictable voyage a couple will ever embark on. Going in blind fuels fear of the unknown and leaves more space for unnecessary interventions to interrupt the safety of the birth process. Knowledge is power!

Look into starting a childbirth class between 20 and 30 weeks gestation. There are so many benefits to completing your course at least 6 weeks prior to your EDD. This allows time for the information to be absorbed. It also gives extra time to account for any potential classes which may need to be pushed out a week or two, should your doula be supporting a birthing family during a regularly scheduled class session, and you still complete the course before the arrival of your baby!

If your Doula teaches a childbirth education class, take her class. You are getting many additional hours with your doula to connect over the birth process. This builds confidence for both mom and her partner in their trust relationship with their doula, it builds a stronger connection, it means that the couple and the doula speak the same “birth language,” and the couple themselves have a much greater understanding of their doula’s vast knowledge base surrounding the unfolding of the birth process. Be sure the class you choose supports how you want to birth and includes education around the stages of birth, coping techniques, as well as partner engagement and preparing the mind, body, and spirit for the journey ahead.

If this isn’t your first birth, but it will be your first birth accompanied by doula support, taking your doula’s childbirth class can bring a refreshing of the soul and even help you bring your vision for this birth to the forefront.

Step 5: Pick 3

Meeting with several doulas means a better chance of finding the perfect doula for your family! So pick 3 doulas who match your criteria from above and schedule interviews.

Doulas offer a ‘free consultation’ to get acquainted. This ‘double interview’ time allows for both the expectant family and the doula to interview one another to see whether they are a right fit.

It is important to see if there is a connection and positive energy, and give you a chance to get a sense of whether you would feel “safe” and “comfortable” to birth with them by your side. Ask questions you have about their profession, business, character, experience, rates, etc.

The doula also needs to ‘interview’ the expectant family to determine whether they feel that they are the right support person to meet your family’s individual needs and vision for your birth experience. Whether they feel comfortable with both the mother and her partner, as well as the chosen care provider and birthing location is important to the kind of care and attention she can devote to that family. Checking in with your care provider and knowing that they are in favor of you having a support person present, and whether they have any doulas they are not comfortable working with. After all, you don’t want to be caught between your doula and care provider! So make sure that the doula you choose feels comfortable not only with your birth setting and provider team, but that your care provider team also respects your doula.

Your doula should be interested in what your vision is for your ideal birth, and they should desire to support you in striving for that vision, as medically feasible. This is your body, your baby, and your birth!

While meeting with 3 is ideal, there are those occasions when you just know right away, in the first interview, that you have found her! … and the feeling is usually mutual! Everything just fits and you know that she is the one that you want to welcome into your birth space, and support you during this miraculous journey!

Step 6: Use her!

You now have a support person whose entire profession, expertise, and knowledge base revolves around pregnancy, birth, postpartum, breastfeeding, newborn care, sleep cycles, etc. Use that resource! Reach out! Don’t be afraid to ask questions or request guidance. This is what they are here for!

Hire early! Repeat hire, early! Hiring before 16 weeks means more pregnancy support and more time to develop a close connection. It also ensures the doula’s schedule doesn’t fill-up without you!

Many doulas offer extended care packages during the postpartum period which gives the family access to the Doula’s educational knowledge base for guidance on sleep issues, teething comfort, sleep pattern guidance, breastfeeding support, referrals to outside resources as a need arises, and so much more, all accessible through baby’s first year of life! This is an incredible blessing, especially for first time parents. This gives continuity of care that doesn’t just end after the baby arrives. Babies don’t come with a manual, and having someone at your fingertips with evidence based information, rather than “forum opinions,” is such a blessing!

For additional thoughts, considerations and ideas, READ HERE!

Intrahepatic Cholestasis of Pregnancy

From ICP Care:

What is Intrahepatic Cholestasis of Pregnancy (ICP)?

ICP is a group of liver disorders specific to pregnancy which interfere with the flow of bile. Bile is a substance produced by the cells of the liver to aid in digestion of fats. During normal liver function, the bile which is produced is transported out of the cells and into the bile duct by special pumps. During Intrahepatic Cholestasis of Pregnancy, the cells are unable to transport the bile out of the cells normally, which leads to bile acids building up in the blood. Elevated bile acids in the blood are associated with increased risk to the unborn baby. It is important to note that Intrahepatic Cholestasis of Pregnancy is not a single disorder, but a heterogeneous group of many different disorders which all lead to elevated bile acids. This means that the disorder presents very differently in different affected women. 80% of cases are diagnosed in the third trimester, about 10% in the second trimester, and about 10% in the first trimester, with documented cases as early as 8 weeks pregnant.

What are the symptoms of Intrahepatic Cholestasis of Pregnancy (ICP)?

  • Itching – The most commonly noticed symptom of ICP is itching which can be moderate to severe. Itching due to Intrahepatic Cholestasis of Pregnancy does not typically respond to antihistamines. The itching is usually not associated with a rash, but a rash can, in some cases, develop as a result of scratching. The severity and location of itching can vary greatly. The most common location of itching is hands and feet, but some women experience itching on the arms and legs, the scalp, or all-over itching. Some women with the disorder itch everywhere except the hands and feet. In the majority of cases, itching is the only symptom reported.
  • Dark urine
  • Pale Stool
  • Right upper quadrant pain
  • Fatigue/Malaise
  • Mild depression
  • Pre-term labor
  • Nausea/lack of appetite
  • Rarely jaundice

What causes Intrahepatic Cholestasis of Pregnancy (ICP)?

Intrahepatic Cholestasis of Pregnancy is caused by a combination of factors including:

  • Genetics – Research has identified several genetic mutations which are associated with ICP. Not all genes have been identified. Many of these mutations cause defects in the bile salt export protein (BSEP), which is responsible for moving bile out of liver cells. Intrahepatic Cholestasis of Pregnancy can be considered a genetic disorder, even when there is no family history of the disorder. Mothers, sisters, and daughters of women affected by Intrahepatic Cholestasis of Pregnancy are at higher risk of developing the disorder, though it is not guaranteed.
  • Hormones – The initiation of ICP during pregnancy is influenced by the high levels of the hormones estrogen and progesterone, which are responsible for maintaining the pregnancy. The high levels of hormones further interfere with the liver’s ability to transport bile acids.
  • Environmental Factor– Intrahepatic Cholestasis of Pregnancy recurs in future pregnancies in 60-90% of cases, which indicates that environmental factors also play a role. It is not entirely understood why ICP sometimes does not recur, but research has found evidence that seasonal influences as well as improved nutrition may play a role. More women are diagnosed with Intrahepatic Cholestasis of Pregnancy in winter months, and selenium deficiency has been linked to the disorder, though it is not known if this is a cause or effect of ICP.

Take a closer look at these causes.

 

What is the treatment for Intrahepatic Cholestasis of Pregnancy (ICP)?

  • Early Delivery – Active management of Intrahepatic Cholestasis of Pregnancy reduces the risks associated with the disorder to that of an uncomplicated pregnancy, but there is no cure for ICP except delivery. Active management includes, most importantly, the medicine Ursodeoxycholic Acid (also known as UDCA, Actigall, Ursodiol, or Ursofalk), and early delivery, typically by 36-37 weeks gestation. In some cases, where medication is not controlling bile acid levels, delivery may occur even earlier.
  • Medication (Medical Option ~ Natural Options listed below) – Ursodeoxycholic Acid is considered the frontline treatment for the disorder. It has been proven safe in meta-analysis for both mother and baby, and research has identified many ways in which it potentially can provide a safer environment and protect the baby against harmful effects of bile acids until delivery can occur. It is a naturally occurring substance in the body, and has been proven to reduce the total bile acids in the bloodstream of women affected by Intrahepatic Cholestasis of Pregnancy. Sometimes other treatments will be used in conjunction with Ursodeoxycholic Acid with the aim of reducing maternal symptoms.

 

What are the risks associated with Intrahepatic Cholestasis of Pregnancy (ICP)?

Intrahepatic Cholestasis of Pregnancy puts affected pregnancies at higher risk for several complications. With active management it is believed that the risk of stillbirth is similar to that of an uncomplicated pregnancy (less than 1%).

  • Pre-term labor/delivery
  • Fetal Distress
  • Meconium Passage
  • Respiratory distress syndrome (RDS)
  • Failure to establish breathing (sometimes called fetal asphyxia)
  • Maternal hemorrhage
  • Stillbirth (Intrauterine Fetal Demise/IUFD)

 

 

Natural Options for the Treatment of Cholestasis

The idea here is to maintain a balance within the body, whereby keeping cholestasis at bay for as long as possible. Supporting the liver through dietary intake, supplements and herbs, keeping the bile acid levels lower for a greater duration of time.

As with anything I recommend to my clients, this is meant as a foundational guide to get you off and running in the right direction, with lots of options. Please do your own research from this foundation. Trust your body and your instincts, go with what feels right to you and listen to how your body responds.

Also, remember that any protocol works best when providing full support to the body. We tend to support one or two areas, leaving other areas of the body to make up the slack, whereby creating an unintended imbalance. The recommendations listed below are meant to be used for complete support for all areas in need during this time. Daily consistency and diligence are necessary.

Always discuss your options with your care provider.

Diet
-or-
     – Ensuring low fat intake, with complete removal of all saturated fats.
     – Ensuring that minimal fat intake is from healthy forms of fat. You may need to adjust some of the brewer’s diet recommendations to extremely cut fat intake. Focus on Fish, fruit and vegetables.
     – Aim for 8 – 10 Liters of water/day. Think of flushing the toxins out.
     – Foods high in Vitamin K, especially K2
     – Natto – Fermented Beans – Very high in K2
    – Get rid of all processed foods; digesting them makes your liver work harder.
– Foods that especially support the liver are apples, blackberries, dark grapes, plums raspberries, beets, asparagus, carrots, celery, leafy greens, onions, tomatoes and watercress. (some of those combined would be a great smoothie!)

 

Supplements
1) Vitamin K2, Jarrow Brand – This brand is specifically derived from Natto.
     – If you feel you need to supplement from your diet.
     – Acid levels need to be in balance for proper vitamin K absorption
     – Again, if you feel you need to supplement from your diet.
     – Selenium deficiency is one of the leading triggers for an increase in estrogen production, inducing bile flow impairment.
     – Lecithin is a type of unsaturated fat that is also referred to as a phospholipid. Your body produces some lecithin naturally, storing it in the bile in your liver to help metabolize fats.
     – It works as an internal lubricant within the body (also great while breastfeeding – prevention and treatment of blocked milk ducts and mastitis.)
4) SAM-e
      – Vitacost & Thrive Market are great places to purchase discounted, quality supplements!
     – S-Adenosyl-L-Methionine (SAMe) is a chemical that’s found naturally in your body that plays a role in liver and brain function. It’s also sold as a dietary supplement to treat a variety of conditions. According to the National Center for Complementary and Integrated Health, there is supporting research to suggest that SAMe is a safe and effective treatment for cholestasis.
     – You want 800mg per day. It is commonly sold as 400mg, so you would need double the dose.
      – Again sold at many natural food markets as well as Vitacost & Thrive Market, online.
      – This supplement naturally strengthens the liver’s structure and function, improves the body’s ability to filter toxins, drain acidic waste and decrease ammonia, whereby opening up the detox pathways in the liver and supporting kidney function.

 

Herbs
     – Nutritionally supports the liver’s ability to maintain normal liver function. It has shown positive effects in treating nearly every known form of liver disease. Milk thistle works due to its ability to inhibit the factors responsible for liver damage, coupled with the fact it stimulates production of new liver cells to replace old damaged ones.

     – Liver, spleen and pancreatic tonic, kidney tonic, helps dissolve kidney and bladder stones, stimulates liver, good for hepatitis, jaundice, anemia, acne and skin conditions. Fresh dandelion greens are highly nutritious and the flowers are edible, too.

Some of the herbs studies also talk about the benefits of artichoke herb, in combination with milk thistle and dandelion, for liver health and function. However, artichoke should not be used, when a blockage in the liver exists, which is what happens during cholestasis.
Tinctures & Tea
     – Liver Tincture
     – Persephone’s Tea This counts as water intake! 😉
          – Steeping this in the correct manner is of the utmost importance.
               – Steep 1oz in 1 quart boiling water
               – Let sit for 2 hours
               – Drink 2 – 4 cups daily

For additional information about ICP please go to icpcare.org.

Download a helpful infographic with embedded links at icpcare.org/images/ICPinfographic.pdf.

 

 

References: