Follow me through my pregnancy

This is the last week of first trimester! Though nothing magic happens when a pregnancy hits 13 weeks, it is a mile marker indicating the first ⅓ (approximately) of the pregnancy is competed and many people experience lessening of some of the challenging symptoms. I have noticed that some days I have been slightly less fatigued. I am still far from my nonpregnant energy levels but I’ll take any kind of improvement. I’ve mentioned before, but I am blown away how different this first trimester is from my previous experiences. This time the nausea, GI changes, aversions, and fatigue are much much more intense. I have several theories as to why, but I may get more answers in the next few weeks… or I may not. Even my growth is noticeably different from my last few pregnancies. It is absolutely true that quite often, as a mother has carried babies before, her body sort of jumps into pregnancy mode sooner, and often “show” sooner. In part, the body remembers, and the muscles have stretched before to accommodate the growing uterus and other hormonal changes, and allow for the room easier than when it is the first time carrying a baby. Though I have personally experienced having a rounder belly sooner with my subsequent pregnancies, I have definitely not experienced such dramatic growth and rounding as I am having this time. Every pregnancy is different. I almost think it is God’s sense of humor helping remind us we always have to trust and will never have all the answers. One theory I have about why this time feels so different is I can’t get the idea there may be two babies out of my head. I have often wondered if this is intuition or if I’m convincing myself because of how this first trimester is playing out! I did finally make the decision to have an ultrasound earlier than originally planned to help determine how many babies I have, or if there are other reasons my fundus (uterus) is higher at this age than expected.

Here’s an interesting thing, the size of the belly is not the same thing as the size of the uterus. As experienced moms show their pregnancy earlier, generally the fundal height, or the measurement from the pubic bone to the top of the uterus, still corresponds to the gestational age. It takes some practice to feel where the fundus is, but working with your midwife or provider can show you how to feel for it. It feels like a little rounded shelf. Cupping your hand slightly and using the edge of the hand where the thumb connects to the palm and gently rolling down from above where we expect your fundus to be can help you feel where the fundus is. After about 13+ weeks you can usually just start to feel the fundus just at or above the pubic bone. At about 16 weeks, the fundus is about ½ way between the pubic bone and the belly button. At 20 weeks it is about at the level of the belly button. Each week beyond that, we typically use a measuring tape and measure from the pubic bone to the fundus. Generally for a singleton (one baby,) the weeks of gestation approximately equal the measurement in centimeters, +/- 2 cm. So at 28 weeks usually the measurement is 26-30 cm, and at 34 weeks the measurement is 32-36 cm. Most commonly, the week gestation matches the measurement in centimeters. Comparing week to week (or appointment to appointment) is more helpful than a single measurement all by itself. The trend is even more helpful than the individual measurements since a baby's position in utero can alter measurements slightly. If I see someone trending on 24 cm at 24 weeks, and 28 cm and 28 weeks, 30cm at 30 weeks, but then 31 cm at 32 weeks, and 32 cm at 34 weeks, I may be more inclined to be more watchful or encourage checking in more. A change in the trend may indicate interference with growth and that is true for either direction. Measuring much larger or much smaller than anticipated can indicate things like growth restriction, low fluid, high fluid, excessive growth (like with abnormal blood sugar) or other concerns. There are other things that can alter the fundal height too, like uterine fibroids or multiple gestation (twins or more.)

Looking at someone’s belly is not the same as measuring the fundus. Let me remind everyone on the planet too: IF YOU ARE NOT THE PROVIDER YOU HAVE NO REASON TO MAKE A COMMENT ABOUT THE SIZE OF THE BELLY. (Yes, I was just yelling.) Even from the provider’s perspective, it should only be discussed in clinical terms, discussing fundal height as it pertains to health, and should be done tactfully. Just like most people understand it is unacceptable to make a comment about someone’s body outside of pregnancy, the same stinkin’ rule applies to pregnancy as well. You (probably/hopefully) wouldn’t say to someone “Woah! Looks like you’ve been enjoying your holiday feasting!” - right, we can all understand that would be tactless and rude. Unless you are telling someone they “look great!” or they are “glowing” or some other complement that makes no reference to size, just… don’t. Commenting on how big or how small, or how someone is carrying is rude. End of story. I can’t even say how many times I have women talk to me, often in tears, about comments they are receiving from family, “friends”, or strangers. I have personally had comments like “wow, how many are in there!?” or “you look like you are ready to pop” (at preterm gestational age no less) or “woah, you are showing already!”. That last one I got this time at 12 weeks, in a rather public setting, from across the room. It just happened to be the morning after I was tearfully self conscious about how large I felt already and going through all the reasonable and unreasonable thoughts along with that. Of course afterwards I think about all the snarky comebacks that would be mildly cathartic. But people, please just hold your peace. I remember a woman I cared for who was sobbing and feeling anxious because people kept telling her she was carrying so small. It got into her head and she was convinced there was something wrong with her baby, that she wasn’t doing enough to nourish herself and that she was a bad mother. Another one was panicked she was going to go into preterm labor because people kept saying she was carrying low. Any comments about someone’s size are just not helpful. Don’t.

People talk about how emotional pregnant women are. It is true that many women feel more intense emotions while pregnant or postpartum. We all blame hormones as if a heightened emotional state is a bad thing. I believe one of the reasons we are in this heightened emotional state is because we are trying to connect to this new person who we haven’t even really met yet, this person who will not have any words to express themselves for years. Yet we need to be able to read them so well to mother them. Women frequently report how their unborn baby is feeling, and even more so, read their newborn better than anyone else in creation. What an honor and responsibility. I believe we have to be in this highly emotionally open place to connect to our baby, to get to know them, to read them, to understand them. We also have to be able to read people and our surroundings very well to keep ourselves and babies safe. It is a horrifying statistic found by a meta-analysis is that around 25% of pregnant women worldwide experience some form of intimate partner violence (physical, sexual, or psychological). If women are unable to sense and respond to our emotional openness, it can literally put them in danger. On a much less severe side, it may help us filter out who are the safest people (physically, emotionally, spiritually) to be with us in this vulnerable time. The way we feel and are responded to can help us evaluate safety, and comfortability to those we can feel safe with our babies. Our most foundational instinct is to protect and care for our babies. So next time you think the pregnant person in your life is being “too emotional,” maybe reassess if there are factors that could be contributing to the emotional reaction. And pregnant women, do not be afraid to feel. Feel deeply. Listen to your intuition. Sometimes a good cry, snack, and nap can be quite therapeutic.

Which brings me to my next topic. Have a snack. Our ability to regulate blood sugar, energy, and even emotional buffering can be highly affected by eating regularly. Pregnancy is a wild time and sometimes the need for food or hydration doesn’t always present itself as hunger or thirst. Sometimes it presents itself in a swift change in emotions or energy level. If you find yourself suddenly having a hard time coping, try a quality snack. This is not to say the emotions of fatigue you felt are invalid, but perhaps the gravity of the sensations are disproportionate.

Thanks for joining me this week. As always, if you have any questions or topics you want me to talk about, send me a message.

This week, like for many others out there, brought with it some more sickness. ‘Tis the season for viruses! New Year’s Eve night out church always has a little party with a message, food, fellowship, games, and bubbles to welcome the New Year. It is generally enjoyed by all ages and is a safe space for those who would not be safe in other NYE settings. My freshly 5 year old (his birthday is on Winter Solstice which I think is extra special) suddenly had a headache during the church service portion of the party. It came on hard and fast and within a few minutes of him clearly starting to feel miserable, I brought him back to the quiet room for parents and young children to snuggle in the dark and see if it helped. When I encouraged him to close his eyes he said his “eyelids were too hot.” Kids have a way of saying things that are unconventional but we know exactly what they mean. Their brains are amazing. The abridged version is soon after I brought him home while my husband stayed at the party (at my suggestion) with the other two kids. One perk of being an on call midwife is often we have both vehicles at an event in case I need to slip out to a birth. As many experienced parents could see coming, we were about 4 blocks from home when he began throwing up all over the backseat of the car. Poor kid. I consider it a personal victory that I was able to get him out of the car, bathed, and put all the soiled clothing/blanket/stuffies into a garbage bag for washing without throwing up myself! Thankfully this part of the illness was short lived and vomiting stopped after about 6 hours. The next day he was still pretty miserable but by that night he slept well, and the following day is generally normal other than residual congestion/sore throat. I fully admit to a generous helping of screen support during the sick day, which almost feels more appropriate on New Year’s Day.

As I write today, I am 12 weeks on the dot. Last evening I found the typical evening nausea/fatigue/general ick, which had been generally declining, was manageable enough to get a small home workout in. Though it was not much, it was decidedly a morale booster for me. Then today, I had my first gym workout in 6 weeks. It is incredible how much muscle mass/ strength is lost with inactivity, especially when paired with decidedly suboptimal nutrition. For the weight lifting I did today, I found the loss set me back about 4-6 months in progress I had made before this pregnancy began. I guess that’s the second law of thermodynamics in practice. Despite the discouragement of loss of strength, and loss of muscle tone in aesthetics, it was a huge encouragement to just be doing some kind of exercise again. Exercise as a multidimensional therapy is really remarkable. I am not just saying this because my husband is a personal trainer. Even before this pregnancy, it is incredible to see the effects of regular exercise on my mental health. I think many people think of the physical benefits of exercise, and they are numerous, and should not be discounted. But, the mental benefits are almost more beneficial at times, and are often more quickly noticeable. The immediate benefits of the release of endorphins from physical exercise are awesome. For me, the quantifiable measurements of physical ability can be a boost emotionally too, even if they aren’t what I want them to be yet. Seeing a measurable improvement in strength can give such a larger boost of confidence than even the physical differences of appearance or ability to move more weight; the progress is almost more encouraging than the actual gains.

This bit is about to get pretty vulnerable… But it feels like the right time to talk about body dysmorphia and low self confidence. Many many people deal with these issues, and they can absolutely be lifelong battles. No matter what kind of physical shape I’ve been in, I have struggled with serious body image issues since teenhood. As a young teen I struggled for several years with anorexia which morphed into what is now termed orthorexia, or an unhealthy obsession with eating healthy food. I’ve ventured into some dark places mentally/emotionally/spiritually that had a major contribution from body image issues. Orthorexia can be so sneaky because a strong focus in healthy eating does not mean disordered eating, but it is a fine line sometimes. Because body image issues can cross into all kinds of areas of physical and mental health challenges, managing these issues should be approached holistically, taking the whole person into account in developing strategies. Over the years of learning and mistakes, I have generally found healthier ways to manage, and find better ways to find the balance of healthy eating with physical and mental wellbeing. Yet again, having a supportive and knowledgeable husband has been invaluable. He is wonderful at helping me seek to improve my health and physical abilities while also balancing it with actual health and quality of life. Overcoming orthorexia isn’t about not focusing on healthy food anymore. It is about finding a healthy relationship with food and eating.

Pregnancy can exacerbate body image issues for many women, myself included. Though for me, the first trimester poses greater challenges in body image perceptions. Maybe because of the work that I do, I can absolutely honor the beauty of a full bodied, feminine, third trimester pregnant body. She is the image of motherhood, brimming with new life. She is voluptuous, the pinnacle of female embodiment, Gaia in carnate. When I am there, I can enjoy the glory of it all. But… the first trimester for me, is full of physical unpleasantness, barely under the surface anxiety, and is not the artistic representation of motherly womanhood. I don't feel like Gaia. I feel like a bloated, tired, sick, lump on the couch. I know where the uterus is and how big the baby is, and the size and shape of my belly is not strictly because of the uterus and baby. I know the social media representations of the first trimester, with people sharing images of bodies that do not look pregnant, are not, and should not, be universally idealized, but I know it still messes with my head (even though I know better!) Though intellectually I understand that I am still growing a new human life, and the changes my body is going through are miraculous and beautiful, my self consciousness has not picked up on that. I can see it for other women. But I have a hard time personally embracing that truth for myself.

First trimester is not often celebrated like later pregnancy. It is the silent trimester. Many aren’t sharing the news of their pregnancy yet, and are dealing with all the ups and downs of first trimester in an unfair isolation. You can’t feel baby movement yet. You don’t have a cute baby bump (though you may have a bigger belly with all the GI changes.) You know pregnancy loss is at its highest. Even many providers are not seeing people or providing a whole lot of care in the first trimester. Other than telling you to take a prenatal vitamin, there is little guidance of nutrition support, stress management, lifestyle adaptations that may be helpful, just a lot of “rules” about what you can’t do (often based on very little evidence.) The common issues of the first trimester aren’t glamorized. People don’t want to talk about gas, constipation, fear, potential loss, and difficulty connecting to the pregnancy. I would love for that to change. For people to get care in the first trimester that goes beyond basic physical needs, but addresses the complex mental and emotional challenges of the first trimester.

I think that is why getting to the gym today felt like the turn of direction I needed. I felt good enough to get out there and do something. Then it felt more normal since it was something that was part of my life before this pregnancy. Next the endorphins of exercise give an immediate boost in mood and feeling of wellbeing. Then of course is the idea that I can start to get back to doing something that makes me feel like I’m me and investing in my health, it helps me feel and be strong and capable. When I feel strong and capable, the body image issues lessen and feel more manageable.

Though this time of year it is totally reasonable to lean more into rest, recovery, and a general decrease in business, do not let yourself miss out on the benefits of some kind of exercise. Get some kind of regular exercise for your physical health, longevity, function, and mental health. We owe it to ourselves. When we are parents, we owe it to our children to invest in our long term health. Right now I am feeling so grateful that I am able to again. Now I only have six days left of first trimester… but who’s counting.

Hey there folks! Sorry I’ve been behind on this, but still at it. This post is going to be double duty and cover both weeks 9 and 10 (now that I am 11 weeks!) First trimester nausea/ aversions/ general icky feeling has continued without significant change, though it is becoming more reliable to be an afternoon/evening thing. Now instead of succumbing at noon-ish, I have been making it till 3-4 PM. I’ll take it as a small victory. Christmas Eve did end in my second episode of vomiting, apparently even the gentle baked potato was too much that evening. But something delightful! Heartbeat heard! Yay! With the doppler I have, I am sometimes able to hear the baby's heartbeat in absolutely ideal conditions (mom with lower BMI, anteverted uterus, cooperative baby) in the latter half of the 9th week. Because I have a retroverted uterus (I’ll explain in a second) usually I am not able to hear until later. This time, since God was giving me a little Christmas gift, I was able to hear for a couple seconds at 10+1 (after searching for about 10 minutes.) And I heard again at 11+1 after less searching. At 9 weeks the baby is about 2.3 cm or just shy of an inch, and at 10 weeks the baby is about 3 cm or 1 ¼ inches. Because the target is so small, and mobile, it can be rather challenging to find the heartbeat this early. Despite being rather symptomatic, it is always encouraging to hear the heartbeat at this stage.

Ok, so what is an anteverted vs retroverted uterus? An anteverted uterus is the most common and considered a normal position where the uterus tilts forward, pointing towards the bladder and abdomen. A retroverted uterus is a common variation where the uterus tilts backward toward the spine instead of forward toward the bladder. It is estimated that 20-25% of women have a retroverted uterus. Medically both are normal. Sometimes a provider will tell you when doing a pelvic exam. Sometimes they won’t. I was *displeased* to hear a story from someone close to me who had a provider give her the strong impression there was something wrong with her anatomy because she had a retroverted uterus. Let me be clear, this is a normal variation. Sometimes people with a retroverted uterus may not show a pregnancy as early, but this is not always the case (I sure show nice and early with my last 3 pregnancies but likely due to bloat and having carried babies before.) Outside of pregnancy, many people with a retroverted uterus experience more lower GI symptoms with their menstrual cycle as the uterus in a proinflammatory state is in closer proximity to the colon. During a pelvic exam or if you were to feel for your cervix yourself, if you are the owner of a retroverted uterus, the cervix may be positioned more forward towards the belly, rather than the cervix being more posterior, towards the back, with an anteverted uterus. Here is a picture that can help. uterus positions

One of the other things happening around me in this timeframe is sickness. This time of year is an absolute breeding ground for all kinds of unpleasant viruses, both respiratory and GI. With people gathering, eating together, being inside, no sunshine (here in New England it feels like we get a whopping 3.5 minutes of sunshine per day right now,) and generally a great deal of sugar consumption, no wonder viruses are having a field day. Especially in pregnancy, it can be both very unpleasant to get sick, but it can be harmful, and sometimes more difficult to manage. I get many questions about what can be taken as a preventative measure and what can be taken when sickness is already underway. For the purpose of this, I am going to focus on respiratory illness, like cold and flu. Let’s talk first about the “hot button” item in the prevention category; vaccines. We do not have vaccines against colds. We have seasonal vaccines that target what is predicted to be the most common strains of flu. One major downside is that no one can accurately predict the future and consequently, the strains that are targeted in each season’s flu vaccine may or may not be “covered.” The efficacy of each year’s flu vaccine is documented here https://www.cdc.gov/flu-vaccines-work/php/effectiveness-studies/index.html. Generally effectiveness is evaluated by reduction in hospitalizations and doctor visits. Unfortunately, the predominant strain affecting our area is subclade K, which is a mismatch for this year’s flu vaccine. As with every medical decision, it is up to the individual, through accurate unbiased information, to weigh risks and benefits of getting the seasonal flu vaccine vs not getting it. I am not going to get into the current COVID vaccine, but it is an option for those who feel it aligns with their healthcare decisions. RSV vaccine is not recommended in first trimester, but is a newer recommendation for people 32-36 weeks pregnant for the primary aim of passing antibodies on to baby through the placenta for passive immunity in the early months on the outside of the uterus.

The single most effective preventative measure against all kinds of viral (and bacterial) illness is regular handwashing. This has been well established for more than 100 years. There are no major health concerns with hand hygiene. Soap and water are best for when hands are physically soiled, after using the bathroom, or when alcohol based sanitizer is unavailable. “Fun” fact, the importance of handwashing is formally recognized specifically in the care of women in childbirth. In the 1840’s Hungarian physician Ignaz Semmelweis observed high mortality from "childbed fever" in a ward where doctors performed autopsies before delivering babies, implementing mandatory handwashing with a chlorine solution, which drastically cut deaths. This observation was made when it was noticed that wards that were attended by midwives (who did not put their hands in cadavers before working with women in labor) had significantly less morbidity and mortality. Some doctors were disgruntled that Semmelweis was implying that they were to blame for the deaths and they stopped washing their hands, arguing in support of the prevailing notion at that time that water was the potential cause of disease. (https://globalhandwashing.org/about-handwashing/history-of-handwashing/) Florence Nightingale, considered the mother of the nursing profession, was also a major advocate for cleanliness including handwashing. Routine handwashing became standard only after germ theory was accepted, with the CDC establishing formal guidelines in the 1980s, solidifying hand hygiene as a cornerstone of infection control. Yep you read that right, formal guidelines for handwashing less than 50 years ago. Science and practice can often have quite a lag time between them.

In terms of herbal support, echinacea is a popular herbal remedy well-known for its immune-boosting effects and broad antiviral properties. It’s primarily used to prevent and treat upper respiratory infections. This Canadian study found that taking echinacea during pregnancy is safe and does not increase the risk of major malformations. It’s also considered safe while breast feeding. Elderberry has traditionally been used to prevent and treat respiratory problems. Studies indicate it may play a role in helping prevent viruses from entering the cell and may also stimulate the immune system (study link.) Elderberry may be a safe option for treating viral respiratory illness, and there is no evidence that it overstimulates the immune system (and this study link.) Though there isn't robust data proving safety in pregnancy (this is extremely rare to have on almost anything) but there are no studies indicating harm either. Traditionally it has been used during pregnancy as well. Vitamin C may help shorten the duration of a cold. Aviva Romm, a midwife, physician, and herbalist, has a great article on common helps for upper respiratory illness as well as dosing and pregnancy/breastfeeding safety considerations. https://avivaromm.com/natural-cold-and-flu-busters/

Our family has been taking extra vitamin C, echinacea tincture, and elderberry tincture. Two out of three kids remained healthy as our entire social circle was affected by upper respiratory illness, and the third kid (the toddler) was miserable for one afternoon and evening but then was just boogery for another week but happy and active. My husband was miserable for one day then had an excellent turn around the next day. He is not the type to be affected by a “man cold.” He will push through almost anything. When he is sick, he is really sick. But thankfully he is usually efficient in his recovery as well. I finally succumbed to the upper respiratory illness and am currently on day 3 but already much better than yesterday. Yet again I will sing the praises of my wonderful husband. I feel nearly useless to household activity for the past several weeks between this sickness and first trimester difficulties. He not only picks up the slack, but takes care of me as well. I have all kinds of negative feelings when I see all these social media references to useless husbands/fathers- those who never/rarely participate in parenting or housekeeping. It is either unacceptable or inaccurate. He even took the lead in Christmas shopping for both of our families. This is what partnerships look like. It is a beautiful thing and both sides are better for it.

With Christmas just a few days ago, I am reminded again of how we observe this celebration of probably the most famous birth in history. A birth to a family who were outsiders in many ways. Mary and Joseph were forced to leave their home at a rather inconvenient time because the government (who didn’t even represent them) demanded money. They were on the outside of their social circle due to the controversy around the conception that they did not understand. They weren’t even able to be housed in a setting set up for human occupation. Yet, it was beautiful, holy, and vitally important for all humanity. (In some traditions, there is talk of a midwife, Salome, who attended Mary, though she’s not mentioned in the Bible.) I think about how the first person to recognize the Savior (who was contained in an unborn baby’s body, and still in the first trimester) was another unborn baby, John. “And it came to pass, that, when Elisabeth heard the salutation of Mary, the babe leaped in her womb; and Elisabeth was filled with the Holy Ghost:” Luke 1:41. Because the baby in Elisabeth’s womb recognized the Savior, she was blessed in a unique way, and filled with the Holy Ghost.

Birth is a supernatural event. It is incredible, holy, and profound. It is such a clear picture of renewal and hope. It is a promise of the future, and it is universal. This event is not only about the baby, but about the mother, and family. As we live in an imperfect world and nature itself feels the touch of contamination, even something as pure as birth can become complicated. Yet, this chance of complication does not discount the ceremony or sanctity of birth. I feel so honored to first of all be a mother, and be the gateway for new life to enter into the world. But I am doubly blessed to be able to attend women in this sacred event, witnessing, protecting, observing, and guiding when appropriate. Guys, my job is so stinkin’ cool.

The start of week 8 included a labor and birth. I am grateful that despite typically feeling pretty fatigued and generally icky at home, the adrenaline of a birth helps compensate for much of it, at least for a while. Though it is not my birth story to tell, I will share the common occurrence which included a number of hours of supportive care, including afternoon, evening, overnight, and into the next morning. It was certainly taxing physically and mentally, but there were a few short intervals allowing naps, thank God! In the early morning hours of that labor I did succumb to my first round of vomiting. Typically it is very difficult for me to progress to actually vomiting due to a throat surgery I had as a teenager (tonsillectomy turned radical- a story for another time perhaps) but apparently this time the reflex was strong enough to result in actual, legitimate, vomiting. A small victory there for me was to be able to separate myself from the family I was serving enough that they wouldn’t need to hear me- I am not a quiet vomiter- while they were working through their own challenges. I got home as the sun rose and fell deeply asleep for about 4.5 hours till I rejoined the world of the living. Wowza, I was wiped out. I will sing his praises again, my husband took care of absolutely everything in our household to allow me to recuperate and be a zombie for the remainder of that day. This man is a treasure. Seriously, please make sure you pick a good one. As the week continued, I had some chunks of time that were easier to deal with first trimester symptoms, and others that were more challenging. Still most food is kinda gross but there are a few things that are going down easier.

So I did warn you all this post would be rather personal. Be prepared. We are going to talk about bowel health in pregnancy. That’s right- pooping. It is an important bodily function that can get a little more challenging for many in pregnancy. Thankfully there is a ton that can help keep things moving and healthy. First of all, I think it’s important to understand why the bowels are slowed down in pregnancy. There is the hormonal component, progesterone, which slows the movement of food through the GI system. Then there are the structural changes, a growing uterus that can compress the GI system. Especially in the first trimester, change from normal diet due to aversions and nausea can also play a role in constipation. When someone becomes constipated, not only is it super uncomfortable, but it can increase gas and boating, nausea, headaches, put extra pressure on the pelvic floor, increase hemorrhoids, and later in pregnancy even cause contractions that may look like preterm labor. No good. So, let's talk about what helps.

Fiber- the standard American diet generally has less than 15 grams of fiber daily. In pregnancy I recommend at least 30-40 grams daily. It is something to ease into though, so if your body is used to 10g and suddenly you give it 50g, you might have a bad time. Some excellent sources of fiber are chia seeds, berries, pears, prunes, avocado, seeds, veggies, lentils, and whole grains. I generally prefer for people to get fiber from foods rather than supplements as the supplements don’t provide a substantial amount, and provide little other benefit. Foods that are naturally higher in fiber also tend to have other helpful nutrients. Like berries have a ton of antioxidants, and chia has protein and omega 3’s. A nice easy meal prep is chia pudding. Add 2 tbsp of chia to 1 cup of the milk of your choice and make it more appealing with berries, or cinnamon and honey, and let sit in the fridge for at least an hour. It makes a tapioca puddling like consistency and is an excellent snack to get more fiber and protein in.

Hydration- fiber works in harmony with hydration. There are some really unfortunate case studies of people going to town on high fiber cereals without adequate hydration which actually causes a more severe blockage. Though everyone’s hydration needs vary, a general guideline is at least ½ your body weight (in lbs) in oz per day. So if you are 150lbs, at least 75 oz of water. NORA tea counts as hydration! Two birds, one stone.

Probiotics- these can be an absolute game changer and have lots of other benefits too including blood sugar regulation, immune system support, and mood stability. Goal here would be 50-100 billion CFU daily, ideally including Bifidobacterium and Lactobacillus genera, with Bifidobacterium lactis and Bifidobacterium longum. This can be achieved by both food and supplementing. If someone is having symptoms of a microbiome imbalance, including constipation,I tend to suggest both food and supplement to address it efficiently. For foods, kimchi, yogurt, kefir, sauerkraut, natto, and other naturally cultured/fermented foods are good sources. When choosing a supplement, I encourage shelf stable with at least 15 billion CFU, with an assortment of different strains. I like to see 7+ strains of probiotics, which are listed on the back of the label. (If you want specific recommendations, please reach out to me, I don’t get any kind of commission here!)

Supplements- magnesium citrate (first choice for constipation) or magnesium oxide are both GI active, meaning they help move the bowels. It is also wise to avoid these preparations of magnesium if there is diarrhea or loose stool, instead choosing magnesium glycinate. Start low, go slow. Iron supplements are famous for contributing to constipation and it may be worth it to try a different preparation if your iron supplement seems to be worsening constipation.

Helpful drinks- Coffee- decaf or regular. If drinking caffeinated coffee, I advise staying under 200mg caffeine daily. If going for decaf, I recommend the swiss water method decaf to reduce the processing and chemical exposure. Another option that can be super helpful is warm water with lemon or apple cider vinegar, especially first thing in the morning. And finally, dandelion root tea can be a gentle way to help eliminate waste.

Setting up for success- Always elevate feet to have a BM: using a step stool or squatty potty can make a huge difference. This habit is important even after pregnancy, for kids, for men, everyone. This really supports the health of the pelvic floor. Walking 30 minutes daily, and/or other gentle exercise like yoga, or swimming, can help support healthy bowel function.

Prenatal vitamins can sometimes be challenging to get in with excessive nausea or aversions in early pregnancy, but we also know that early pregnancy is a somewhat more vulnerable time in pregnancy. If your regular prenatal vitamin isn’t going down well, or staying down well, a few things that can help is taking it at a different time. Even though we call it morning sickness, it knows no time limits. For me this time, I actually tend to do better in the morning and feel crummier as the day continues. Aim to take your prenatal when you tend to feel better. Or even consider parring down for a short time to include one that does not have iron, or selecting specific nutrients to seek out specifically. Some people opt to not take a traditional prenatal vitamin, and seek a more whole food based option, including beef liver or organ complex. It is true that liver especially has a higher amount of folate (not folic acid) which is very important for healthy neural tube formation, and can be used even for people with MTHFR, unlike folic acid. (Quick intro to MTHFR- (methylenetetrahydrofolate reductase) refers to a gene that provides instructions for making an enzyme crucial for processing folic acid and converting it into the active form, methylfolate, which the body needs for essential processes like methylation, DNA repair, hormone balance, and neurotransmitter production, and neural tube formation. Variations of this mutation are common, with some estimates as high as 20% of the population having some decreased enzyme function. The MTHFR gene can slow this conversion, potentially leading to higher homocysteine levels and impacting various bodily functions, from mood regulation (depression, anxiety) to cardiovascular health. Additionally, there is evidence that people with MTHFR can not only have difficulty converting folic acid into folate, but can have a toxic build up of folic acid.) It also happens to be one of the best sources of choline, a nutrient that is too often overlooked in pregnancy. Too bad liver is gross, in my opinion. I opt to take it in capsule format when I can right now due to the nausea. I do not tolerate taking as much iron capsules as normal right now, but any time I can get it in, it is better than when I don’t. Seriously folks, just do your best with first trimester. It is hard.

Let me know if you have any questions you want me to address in upcoming posts! Thanks for joining me.

I am writing this post a little late now that I’m 8 weeks and 2/3 days. Next time I’ll share the excitement that 8 weeks and 0 days brought, but you’ll have to stay tuned.

Week 7 brought quite a bit more nausea. No vomiting at this point, but lots of gagging and retching. At least I don’t have to worry about dehydration! (Got to find that silver lining.) Though absolutely no food is enjoyable right now, some foods are more tolerable. Generally carbs are easier to manage, but other things are not always logical on the surface. For two days the only food that seemed approachable was basmati rice topped with kimchi. Pregnancy is weird. In a delightful outlier, one morning an everything bagel with smoked salmon, avocado, and cream cheese was actually pretty nearly enjoyable! Seek out protein however you can tolerate it, but just survive. Hydration is helpful, and electrolytes in hydration are good too. Granted, most of the time it may not be tolerable to drink a whole glass of fluid in one sitting, but rather sip throughout. I also have found decent help in the vitamin B6/ginger candies. The moral of the story here is do what you can.

Let’s shift gears and talk about starting care and what kind of provider options there are for people seeking maternity care by a trained provider. Two main categories are physician and midwife. In each of these there are a number of subtypes. For physicians, there are obstetricians and family practice physicians, though obstetricians are far more common than family practice physicians. In the USA, the vast majority of people receiving maternity are getting their care from obstetricians. This is different from many other developed nations where the majority of people are getting care from midwives, and higher risk pregnancies are cared for by obstetricians. For midwives, there are several options as well. Nurse Midwives (CNM,) are recognized and licensed in all 50 US states. Professional Midwives (CPM) are nationally credentialed and many states provide licenses for CPMs, though not all. Certified Midwives (CM) are more akin to CNMs, though without the nurse background, but CMs are also only licensed in a handful of states. Finally there are traditional midwives. This is the oldest style of midwifery training that usually has a long apprenticeship model and is how midwives have trained for thousands of years. (Yes, the midwives of the Bible were traditional midwives.) We are going to go into more detail about each.

Obstetricians are physicians who are trained in medically managing maternity care and perform surgery like cesareans. They almost always work in a hospital setting. If there is a medically complex pregnancy, it is likely that an obstetrician is going to be the best type of provider to manage the medical care of the pregnancy. Certainly, if cesarean is warranted, an obstetrician is going to be the best provider type. Of note, there is a specialty type of provider called Maternal Fetal Medicine, MFM, who is a high risk pregnancy specialist. Typically, MFM work in conjunction with a primary maternity care provider- both midwives and physicians- and do not attend births. It is estimated over 85% of pregnancies in the USA are cared for by an obstetrician. Obstetricians have been around since the 1800’s. There is a whole interesting history of obstetrics taking over the majority of maternity care from midwives, but that is beyond the scope of this post.

Family Practice providers are physicians who are primary care providers for all ages and sometimes also provide maternity care. Recent data indicate that nationwide, about 7% of family physicians report attending births, but in rural counties, 17% of family physicians report attending births. Reports indicate most family practice providers who do attend births, are usually less than 25 births per year.

Certified Nurse Midwives, CNMs, are licensed in all 50 states. To quote my alma mater, Frontier Nursing University;

“A Certified Nurse-Midwife (CNM) is a primary health care provider to women of all ages throughout their lives. CNMs focus on gynecologic and family planning services, as well as preconception, pregnancy, childbirth, postpartum and newborn care. They also provide primary care such as conducting annual exams, writing prescriptions, and offering basic nutrition counseling.

Certified nurse-midwives are advanced practice registered nurses (APRNs) backed by the American College of Nurse-Midwives. To become a CNM, registered nurses must graduate from a master’s or higher-level nurse-midwifery education program accredited by the Accreditation Commission for Midwifery Education (ACME) and pass the national Certified Nurse-Midwife Examination through the American Midwifery Certification Board. All CNMs must hold state licensure.”

Most CNMs work in a hospital setting, though according to recent data, there are growing numbers who work in out of hospital settings attending community births, like me!

Certified Professional Midwives, CPMs, are direct-entry (meaning non-nurse) midwives certified through the North American Registry of Midwives (NARM). They specialize in out-of-hospital births and are trained through MEAC-accredited programs or the Portfolio Evaluation Process (PEP). They emphasize natural birth and low-intervention care, typically attend home births or work in freestanding birth centers, have legal recognition in 30+ states, do not have prescriptive authority, and often work independently or in midwife-led teams.

A CM (Certified Midwife) is a non-nurse midwife who completes a graduate-level midwifery program, passes the same national exam as a CNM (Certified Nurse-Midwife), and provides comprehensive women's healthcare, but unlike CNMs, they don't have a nursing background, though they offer similar services in states where licensed (like NY, NJ, CO, MD). They focus on pregnancy, childbirth, postpartum, and gynecological care, working in hospitals, birth centers, and homes, with their scope defined by state laws. The CM credential was developed in 1994 in order to expand access to midwifery through multiple educational pathways.

If you prefer, there is a handy, though bulky, chart helping to underline the similarities and differences of CNM, CM, and CPM. Comparison of Certified Nurse Midwives, Certified Midwives, and Certified Professional Midwives

Then, of course, there are traditional midwives. A traditional midwife provides pregnancy, birth, and postpartum care based on ancestral wisdom, community experience, cultural practices, and traditional learning (like apprenticeships.) They view birth as a natural process, a ceremony, not a medical event. They often serve rural or underserved areas with personalized, family-centered support and do not carry formal medical credentials like those of CNMs/CMs. They offer culturally relevant care, often speak local languages, and allow family presence but generally are limited in ordering labs/imaging or file birth certificates like certified professionals, and do not have prescriptive authority.

In general, physicians are taught that pregnancy is a medical condition that requires medical management. Midwives are taught that pregnancy is a normal physiologic event that can become medically complicated. There is even yet another option- choosing to have no trained birth attendant, a “free birth.” Admittedly this option makes me nervous, but I believe people should have the right to choose that option as well, as long as they are fully informed of the pros and cons.

There’s a whole layer of discussion about the pros and cons of choosing a licensed vs unlicensed provider and much of it can depend on the regulations of licensure in the state and the priorities of the family seeking care. For example, some states have extensive regulations around licensure and can often limit the scope of practice significantly more than full scope of practice allotted by the licensing board. This is decidedly a downside in many cases. Thankfully, where I live in CT, the parameters put on me by my license are quite minimal and I do not feel that they limit my ability to practice to the extent of my license. In CT, I am legally required to submit a birth certificate for any births I attend. In other states like CA, licensed midwives are not legally permitted to care for breech babies, multiples, pregnancies beyond 42 weeks, cannot perform ultrasound, and more- even if their training encompasses these aspects of care. In Nebraska, Certified Nurse Midwives (CNMs) are effectively prohibited from attending home births, as state law allows only physicians to attend, and physicians in Nebraska generally do not provide this service, making it a felony for CNMs to attend home births! (Like, what country are we even in!?) Because of some of these egregious limitations on licensed providers, there is a whole underground movement for unlicensed providers in states where laws severely limit people’s choices.

It is also worth mentioning that many people have or are developing serious aversions to the medical industrial complex as they find the whole system corrupt and want to distance themselves from an industry that is frankly founded in some pretty icky stuff ethically. There are families who purposefully seek out a maternity care provider who was never part of the modern medical system, like a traditional midwife. There are differing opinions from those within the medical system that are aware and disgusted by the rampant corruption in the medical system about whether it is better to try to fix/alter the system from within or eschew the system altogether and operate in an entirely separate system. Again, this topic is so deep that I can’t possibly do it justice in this blog post.

As people are seeking a maternity care provider there are many factors that go into the decision making process; location of birth, affordability, training, autonomy, legal parameters, cultural practices, medical history, and much more. I personally believe there is a situation for each provider type and if people have access to all provider types based on their needs, the whole system works together better. Our country needs to do a much better job with integration of the different provider types and birth settings. I encourage people to evaluate their vision for their experience and evaluate the options in their area. Thankfully, even if care is started with a provider that does not feel like a good fit, you do NOT need to stay with someone you do not feel comfortable with. This goes for maternity care, pediatric care, primary care, and so on.

As many people are starting prenatal care around 8-10 weeks, I encourage people to consider their options. Your pregnancy is yours.

Thanks for reading! Until next time.