This video explains what the pelvic floor muscles are and why they're important to exercise in pregnancy. For more info about Kegels and other important exercises for pregnancy and postpartum, take my 10-week Birth Boot Camp!
Women obviously want to do what's best for their babies, and the idea of taking a prenatal vitamin and other extra supplements to guarantee a good outcome is very appealing. It's so easy to take a pill every day! I want to rock the boat a little and point out some things you may not know about whether supplements are always needed or even beneficial.
Studies have shown no clear and overwhelming benefit to supplementing all women in pregnancy with vitamin C, vitamin E, magnesium, calcium, and iron. Certainly, in some cases of malnutrition or an absorption disorder a woman would greatly benefit from something she is lacking, but this should be done with her health care provider on a case-by-case basis.
It seems the message most American women get is that taking a prenatal vitamin will ensure they have everything they need for a healthy baby. They are often instructed to "watch their weight", but not given much education about what is truly unhealthy to eat. Often, diet is given little attention until a problem has already surfaced and there is little time to correct the issue. Ideally, women who are planning on getting pregnant will be eating a very healthy, varied diet BEFORE they conceive. If a prenatal vitamin was a cure-all, our pregnant women and babies would be a whole lot healthier.
Then there's the point that too much of any one thing is usually not a good idea unless there's a clear reason. Our bodies try to keep all chemicals within ranges. For example, too much iron can be very constipating, too much calcium can lead to heart disease, and too much potassium can result in stomach upset.
There's also quite a difference in the quality of prenatal vitamin. The cheapest ones probably aren't doing much of anything for you. In order to make them cheaply, the nutrients are in a synthetic form that is not in a form readily absorbable by your body. The highest-quality ones are food-based, so your body actually has the correct enzymes and knows what to do with it. Think about how much dehydrated vegetables there are in a few prenatal vitamins. Couldn't you eat more than that every day?
The point of this is not to tell you not to take prenatal vitamins (I take them), but rather to remind women that diet is the first and best line of defense in a healthy pregnancy and life. I'm afraid some women are taking their vitamins and then eating junk food all day. Prenatal vitamins are there mostly as a back-up for those who are not getting proper nutrition either because of a poor diet or genetic metabolism problems, but does not lead to as equally good outcomes as great nutrition does. Ask yourself: how's my diet?
To read more about individual supplements from previous posts:
Because we are learning how important certain nutrients are to pregnancy it has become common to just supplement one or a few of these minerals or vitamins in order to ensure good health. The pharmacy area of any store has many individual vitamins or minerals you can buy. But this doesn't often work. Take the case of calcium, for example.
Since we know calcium is liberated from a mother's bones to build baby's bones and then to make milk it seemed like common sense to have pregnant and nursing women supplement with large doses of calcium. The problem is, after decades of that advice we're learning that women who supplement actually liberate more calcium from their bones and that after weaning their baby women naturally put down extra calcium back into their bones leaving them stronger if they are taking in normal (dietary) amounts of calcium. That's amazing! Your body uses your own calcium to grow your baby, then after about 6 months of nursing begins laying down stronger bones in preparation for your next pregnancy.
A large Harvard study of nurses backed up these findings, showing that those who took a calcium supplement broke bones more often than those who didn't. Almost as if your body knows what it's doing and adding mega amounts of one mineral upsets the delicate balance your body is constantly working to achieve! This is a case of more is not better. Too much is harmful. It is important to remember that it is not only calcium that our bones are made of, even though it's the one we hear about most often. Protein, magnesium, sodium, and phosphates are equally important in bone composition.
Getting your daily dose of around 1200 mg calcium shouldn't be difficult if you're eating a healthy, balanced diet like you should in pregnancy. Calcium is in many foods, from dairy to many vegetables. It's also added to many foods, like orange juice. In fact, dark leafy greens, sardines, and nuts have good amounts of calcium. Another thing to know is that your body seems to only absorb 500mg of calcium at a time, so it's best not to take all your calcium in one supplement.
Unless you have a problem absorbing calcium, you're not eating a healthy diet (in which case you'll be deficient of many nutrients), or some other reason your doctor thinks you need to supplement, the evidence is pretty clear that women, even pregnant and lactating women, don't need extra calcium supplements.
Informed consent is a legalese kind of word that most of us brush past. But what does it really mean? Basically, it means that health care providers all need to explain the risks, side effects, and purpose of every drug and procedure they give a patient. Just because you walk through the doors of a hospital or hire a midwife does not give them permission to start doing things to you without explaining.
Here are some relevant statements from ACOG's (American Congress of Obstetricians and Gynecologists) statement on informed consent, so that we know what the professional standard is, according to them. Midwives would have very similar ethical statements.
I want to drive home the point that informed consent is vital to making decisions about our health. There is no way anyone can decide what they want to do unless they fully understand what the risks and benefits of the procedure/drug/test is. This ensures that the responsibility is put exactly where it should be: on the patient. After all, they are the one who is most directly affected by the outcome, good or bad.
When it comes to labor and birth, informed consent can be hard to come by. Mothers may be working through contractions and vulnerable. Most of the time, care providers are going to do things the way they were trained to do them-and that may or may not be what you as the patient want. That's why it's so important to talk about your birth plan before labor begins. Some parents think they will just tell the people in the room what they want in the midst of it all, but that rarely works out. In my childbirth class we spend a whole class on birth plans and all your choices. This is a two-hour class that takes place with everyone in their "right mind". It just cannot be reproduced between contractions!
I have heard several times that a big part of getting toxins out of our bodies is to cause sweating and then the toxins will leave in the sweat. Sounds easy, right? This is why people flock to saunas. Unfortunately, sweat contains only tiny amounts of toxins. I guess things that sound too good to be true are in fact that. Maybe the confusion is because some tests have been developed to detect illegal drug use by testing sweat. These are detecting tiny amounts of the byproducts of these drugs. I have not been able to find any instance of an infant being harmed by coming into contact with sweat or of the effects of drugs being shortened by extreme sweating. The good news is that there are plenty of other ways to rid our bodies of toxins even if sweating isn't one of them. We can pee and/or poop out many toxins if our kidneys and liver are working properly, so that's where our focus should be.
What sweat does contain is small amounts of minerals and vitamins, so if you're purposely sweating profusely to get rid toxins you're likely only losing your prenatal vitamin. Calcium, sodium, magnesium, and other nutrients that are needed to build your baby's body and keep yours functioning properly are lost in sweat. Sweat is mainly water because the whole purpose is for the body to cool itself. Make sure if you're sweating that you're also drinking enough water so you avoid dehydration. This ironically will cause the toxins to be kept in the body because your kidneys don't have enough water to do their job. In addition, dehydration and loss of salt through sweat may increase chance of preeclampsia and low amniotic fluid.
I want to make sure to mention some cautions about detoxification in general for this time in life. Breastmilk can contain toxins that have been stored in your fat cells. This is why weight loss is suggested to only be 1 1/2 pounds a week at the most. We're all exposed to environmental toxins, so try to limit it where you can. Chemical cleaning products and pesticides shouldn't be handled by pregnant or breastfeeding women, or if absolutely necessary gloves should be used. Storing and reheating food in certain types of plastic is another source of toxins that is often overlooked.
As if a diagnosis of gestational diabetes (which can result in numerous tests, blood draws, food record-keeping, and daily finger-sticks) wasn’t bad enough, many women are left discouraged towards the end of their pregnancies to hear there is a risk of stillbirth along with their diagnosis. The last several weeks often involve ultrasounds and other tests, and then induction is brought up early. After all this, many moms feel like the whole pregnancy and birth are out of their control and they’re “defective”. So let’s look at the actual risk of stillbirth and the implications that has on you and your baby. (If you're not sure what gestational diabetes is, you can read my overview article.)
Physicians have thought there was a relationship between gestational diabetes and stillbirth for years, but in the biggest study on gestational diabetes there was NO association with stillbirth. The risks of gestational diabetes were: C-section, pre-eclampsia, large-for-gestational-age baby, shoulder dystocia, prematurity, birth injury, stay in the NICU, and hyperbilirubinemia (jaundice). Keep in mind several of these problems are iatrogenic (caused by health care providers), and often are a result of trying to prevent other problems, like stillbirth.
As I heard an OB say, “Because of the risk of stillbirth with gestational diabetes we induce between 37 and 38 weeks.” I’m not sure who he meant by “we”, but that’s not a general recommendation. From the ACOG bulletin on gestational diabetes, “When glucose control is good and no other complications supervene, there is no good evidence to support routine delivery before 40 weeks of gestation.”
Another study published in 2012 looked at the risk between letting the pregnancy last another week and a stillbirth occurring and the risk of the newborn dying. It wasn’t until the 39th week of pregnancy that the risk of stillbirth became evident. But to understand if this applies to your situation, understand that “this study did not differentiate between those who were only diet controlled and those who required medical therapy; thus, it is likely that our study population could have more severe disease, representing a population at higher risk of stillbirth.” In other words, if your blood sugar levels are under control there is no evidence that you have a higher chance of stillbirth than someone without gestational diabetes. GD is also associated with preeclampsia, which would also might be responsible for some of these stillbirths. Research to tease out all these factors in ongoing.
According to the study who found an increase in stillbirth, it is of note that 1,518 women must be induced at 39 weeks (and take on the risks associated with that) to prevent 1 stillbirth. Also, with gestational diabetes even at 40 weeks only 4.4 stillbirths occur in every 10,000 pregnancies. Even the authors do not recommend that all women be induced at 39 weeks “Because the absolute risks of stillbirth and infant death are so low, an increase in short-term neonatal morbidities such as NICU admissions associated with a policy of early delivery may have a public health ramification that overshadows any small mortality benefit.”
Since many moms, especially those with gestational diabetes, are often advised to come in for tests such as an ultrasound and a biophysical profile, it is important to note that a Cochrane Review (that looks at all studies) has found no evidence that the test improves outcomes. ACOG also does not recommend testing when blood glucose is under control with diet. That's something parents have a very hard time understanding when faced with the pressure to undergo them. These tests increase Cesareans and inductions, but do not decrease death or low Apgar scores. This should be made clear to everyone choosing to undergo such a test. Ultrasounds are not reliable in determining the baby’s size, especially as the pregnancy progresses.
I would also like to add into the mix my perspective from a breastfeeding standpoint. There are many factors associated with Cesareans, inductions, and prematurity that negatively affect breastfeeding both for the baby and from the maternal side. These kinds of consequences are often not even considered when a family is deciding between an induction or a naturally starting labor.
To summarize (and I really tried to keep this short & sweet!), moms should ask their care provider:
*what their individual risk is with gestational diabetes based on their own blood sugar readings and personal history
*what they can do to keep their glucose levels low before resorting to medication
*what the side effects of any medication will be (insulin and related drugs often affect the baby after birth, necessitating more tests)
*why specifically an induction is being suggested. Is there any indication the baby is in trouble? How reliable is the test?
*if the baby is showing signs of distress, why an induction would be a better option than an emergency Cesarean?
*have they ever seen a shoulder dystocia? How did they handle it?
*how any intervention could affect your long-term goals, such as number of children or breastfeeding
If you’d like to read more on the subject, here is an excellent review that includes more relevant studies and information on treatment options for GD.
There's a lot of misinformation and old wives' tales out there about alcohol use in pregnancy and breastfeeding. It's hard to know who to listen to on either extreme. Is it fine or totally off-limits?
Alcohol in Pregnancy
The consensus from the medical world is that "no amount of alcohol in pregnancy is safe". This doesn't mean that a few drinks before you knew you were pregnant is definitely a problem, but there have been no studies showing that some amount had absolutely no effect. The best thing to do is to have a healthy, whole foods diet and abstain from alcohol when trying to conceive and during pregnancy. That way, no matter the outcome, you know you did everything you could to nourish your baby.
Large amounts of alcohol while a woman is pregnant can lead to Fetal Alcohol Syndrome in her baby. This causes neurological damage that is permanent. It's especially harmful to do a lot of drinking early on in the pregnancy, when the baby is still developing. Damage at this stage could be severe. If heavy drinking is continued through the pregnancy the baby can have withdrawal after birth, which is obviously not what you want to be dealing with.
Alcohol in Breastfeeding
Breastfeeding gets a little more complicated when it comes to alcohol. The good news is, after 9 months of no margritas you can have one! The caution is that the alcohol could still have a negative effect on your baby, so there are some guidelines.
Think of your breastmilk just like your blood. After all, milk is made frm the substances carried in your blood. We all understand that the alcohol level in your blood goes up as you drink and then gradually goes down when you stop. The same happens with your milk. The alcohol is cleared from your milk when you stop drinking. The rule of thumb is to wait one hour per drink to nurse your baby. If you're still feeling the effects of the alcohol then you should probably wait to nurse.
Some people have recommended beer as a galactagouge, or a food that increases milk supply. There is little evidence that this works, because beer is not made the same way as it used to when it was recommended. It was only the stout beers that had this positive effect. You can read more about the history in this article.
Other kinds of alcohol, especially large amounts, have a negative effect on milk production. They reduce production of oxytocin, which is necessary for milk let-down. Because of this, it's probably a good idea to keep from drinking until your milk supply is well established and your baby is gaining weight well, and even then keep from overindulging.
One thing I really stress in my childbirth classes is the importance of a birth plan. This is a written plan listing what you want in labor and what you'd rather pass on.
Some parents don't see the point because they love their provider and feel like they're really on the same page about the birth. The problem is, you hire a doctor or midwife for one of the most important events of your life without ever having seen them actually do it! Coming into a prenatal appointment with a birth plan really lets you have a conversation about exactly what they do and do not do at births.
Another barrier I've heard to birth plans is that couples think they can just advocate for themselves at the time. The problem is, labor is not a time a woman can -or should- be thinking through options and conversing with strangers. She needs to be focusing inwardly on what her body is doing. Especially at the end of labor she often becomes very compliant and will just do what she's told because it's just too much to argue. With my second birth I thought I didn't need a birth plan, but boy was I wrong! It was probably my most textbook birth, but also my least favorite experience because I felt pushed around and ignored.
When you think about it, a birth plan is really just as much for your doctor or midwife as it is for you. Most health care providers really want you to be happy with your birth, so they'll bend to your wishes to a certain extent. The birth plan is not about making demands as much as just communicating your desires so they know. After all, it's really not fair to be upset they didn't do something you never asked for! If they seem unreasonably unyielding then it's a good sign you're not a match and you can look for a provider who won't have to feel uncomfortable following your birth plan.
I'd ask you to take a look at this article about interventions that are often overlooked. For more about how to write a clear birth plan and what kind of things to put on it, take my birth class!
In years past, preeclampsia was explained as high blood pressure in pregnancy that also had protein spilling into the urine. This led care providers to rely only on these markers to determine which pregnancies were at risk for turning into preeclampsia. One of the symptoms, swelling, was treated with salt restriction. New information, however, shows that those effects are only symptoms of something affecting the entire body. There seems to be more evidence that a healthy diet can prevent the development of preeclampsia and a dangerous pregnancy. Preeclampsia occurs in 11% of all pregnancies. No reliable treatment has been developed because there is little understanding of exactly why it occurs. We don't often lose mothers from it in the developed world because it resolves with the end of the pregnancy, so doctors will do a Cesarean and deliver a premature baby if the mother is badly affected. Preeclampsia is the cause of most cases of neonatal death and a large contributor to prematurity.
We know now that the placenta plays a big role in preeclampsia. We know this because not only does it resolve once the placenta is delivered, but there are also rare instances of a hyatiditiform mole (where there is no baby but placental tissues remain) and they can cause preeclampsia, too.
Basically, the placenta is not doing its job of nutrient exchange for some reason. It looks like that reason may be that the uterine lining does not relax enough to allow the placenta to implant properly. Specifically, there is not enough oxygen getting to the placenta while it is developing in the first trimester. The amazing placenta does its best at trying to compensate by branching its blood vessels and growing into odd shapes. It may help to think of preeclampsia not as a disease in and of itself, but more as a symptom of something not working with the placenta. Preeclampsia is also associated with diabetes, multiple gestations, and high blood pressure.
We think the problems the placenta has stems from inflammation and oxidative stress. There are many similarities between preeclampsia and atherosclerosis (hardening of arteries). It shouldn't be any surprise, then, to be able to see lower rates of preeclampsia in well-nourished populations. Specifically, changes that reduce her LDL levels. Vitamin C, Vitamin E, and iron probably also have a role. Certain types of fats are known to increase inflammation, like omega-6, while omega-3 has the opposite effect. Another recent discovery has been the influence of sleep apnea on this oxidative stress. If you snore or are excessively sleepy in the morning, you might want to talk to your provider about ways to improve your sleep.
Some recent studies have found these differences:
Women who develop early-onset preeclampsia drank more sucrose-containing soft drinks, and consumed more calories and polyunsaturated fats. 
Women who increased their calcium reduced their chance of developing preeclampsia by 32%. 
It occurred to me as I read through all the studies that all the supplements that show promise are easily available in a well-balanced, whole foods diet like I teach in my childbirth classes. Many pregnancy complications and health problems in general can be alleviated or reduced when eat plenty of healthy foods, yet the studies are trying to narrow it down to one thing that can then be supplemented in X amount in a prenatal vitamin. I really think it's much more than one nutrient we need or one type of food we need to avoid. So here's the bottom line for all women who are pregnant or will become pregnant in the future. The best way to prevent preeclampsia is to EAT WELL. It's not fancy or highly technical, but it makes sense when we think about what's most natural. Please don't put yourself in the position of having to deal with a preeclampsia diagnosis that can make you choose between your health and your baby's.
I'm a natural childbirth educator, lactation consultant (IBCLC), and doula in Athens, AL. Here is where I put healthy recipes, current research, and helpful articles for pregnancy, postpartum, and life in general. Check back often!