Other than Prenatal Care, there are 7 very important things for all pregnant people to remember 

Nutrition

• •   Your food builds your blood, your cells, and your brain chemisty. Like you, your baby is literally created by the food you eat. When working with clients, keep in mind that everyone is on their own journey and their own timeline. While unprocessed food is optimal, keep in mind that individual diets are unique and improving upon what you consume is the most important thing. When possible, eat foods that are biodegradable and require refrigeration. While pregnant, don’t be concerned about how much weight you gain, be more focused on what you eat to gain it.

  • Eat 80-100gm protein per day as a goal for a single fetus pregnancy. Protein grows healthy, more compact babies, while carbs grow bigger, fluffier babies. Every snack or meal should include a protein source. 

    • • If you can only make yourself eat processed carbs in the first trimester, that's okay! Most people are unable to eat anything green at the start of pregnancy. Just try to avoid binging on sweets - make your sugary treats just that - an occasional treat!

      • If you have a super sweet tooth and find you're unwilling to eat most things that aren't sweet, protein is even more important to include. Are you a daily poptart eater, and you're not remotely interested in giving that up? Add peanut butter on the side, for example

  • Eat as many vegetables and fruits as you want – especially dark leafy greens such as spinach, kale, dandelion. There is no reason to limit the amount of veggies and fruits 

  • When possible, void “simple carbs” like potatoes, pasta, rice, flour, and sugar. If you enjoy breads, try to enjoy more whole grain and brown breads. If you can skip the bread, even better!

  • When considering “empty calorie” foods like icecream, cupcakes, and brownies, treat yourself occasionally and make it special. If all you can eat is popcorn for the entirey of your pregnancy, it is more important to feed yourself than it is to lose weight while vomiting up a rainbow of veggies and protein

Hydration

• • Water is 100% necessary for your body to function properly, and its demand increases while you're pregnancy. Symptoms that you aren't getting enough water include, low blood pressure, dizziness, constipation and preterm labor. Especially if you are a member of a higher risk population, make water a priority. Keep a large container of water with you all day, and leave filled glasses in places you frequent, to remind yourself to drink at least 4-6 quarts daily minimum

Sleep/Rest

• • Pregnancy is the perfect time to learn to listen to your body when it comes to your physical need for rest. The hormones of early pregnancy make people extra sleepy, so take frequent breaks off your feet, guilt-free naps throughout the day, and give in to early bed times. Your sleeping habits may change throughout pregnancy, and learning to work with your body to get the sleep you need will help you to trust your body more fully during labor

  • Some symptoms of not enoug rest are nausea and vomiting, dizziness, swollen feet and ankles, increased blook pressure, irritation, and generally feeling "gross" 

Exercise

• • Stamina is required for both pregnancy and birth. Moving your body will help you feel better while pregnant, it will help your body perform better in labor, and it will help you heal better after delivery. 30 minutes of movement a day is a requirement. Walking is highly recommended, if you are unable to do anything else and have the capacity to walk.  Swimming & stretching are also highly recommended. 

  • Don’t start a new exercise routine unfamiliar to your body 

  • Don’t do sit-ups or other exercises that expand your abs. This can cause painful diastasis recti, which is something that will effect the rest of your life post pregnancy

Stress

• • Studies show that stress alone can cause medical problems to arise during pregnancy. Identify what your stressors are, and deal with them promptly. 

  • Do what you need to reduce stress: avoid the stressor when possible, and reduce the amount of time you experience them when avoidance isn't possible.  Pregnancy is a short time, and you may find that you need to make radical changes; the potential consequences of not doing so can create medical issues for both yourself and the baby

Habits

• • If you haven’t had motivation enough to kick a bad habit prepregnancy, let the reality of growing a new human life motivate you. Everything that enters your body grows your baby, so stop all smoking, drinking and recreational drug use if possible. Substance use and abuse may harm your baby, and can cause life long consequences

Sexual Health

• • Humans are sexual beings. Unfortunately, most of us have trauma, baggage and bad experiences in our histories. Birth is a sexual event, and it requires that many of us redefine our idea of what sexual energy is, to allow it to encompass birth. Your sexuality needs to be embraced, warm and satisfied to be healthy. You do not need a sexual partner to get these needs met. If you are able to, address past issues so you can find a place of peace with it,e ven if just during labor and birth. Optimised sexual health makes physiologic birth healthier, and lowers the risk of anything going sideways.

Pregnancy test

• How - Pregnancy tests tell you if there is hCG in your system, which is hormone that the body produces during pregnancy

• When - At home pregnancy tests can give a positive test result as early as 10 days after conception. A blood draw can be an even earlier indicator, as the hCG levels increase in the blood before the urine

• How to - Carefully read the instructions, as everyu pregnancy test is different. If possible, take the test first thing in the morning, the part of the day that the urine is most concentrated. Avoid drinking fluids before taking the test.  Set a timer for the amount of time the instructions tell you to wait. If you leave it for too long, or look too early, the results you read may be incorrect

• Pro tip - Due to regulation, pregnancy tests that cost $1 are as likely to be accurate as tests that are more expensive

Finding a care provider

• • Where do you want to give birth? Look into all of your options, if you can. Birth centers, Homebirth, and Hospital birth all have pros and cons. There is no such thing as 100% safety, as birth is an unpredictable event, and looking for a provider is one of the first steps in normalizing a risks vs benefits approach. Deciding what safety looks like for you and your family will help you come up with questions for potential providers. Feel free to contact me if you need help with this process

  • What our animal bodies need in labor is an environment where it feels safest to be immensely vulnerable. The beginning stages of labor are especially assisted by the para-sympathetic nervous system, which allows you to rest and your cervix to open. The latter part of labor makes a switch in the brain to the sympathetic nervous system, sometimes called fight or flight, when the pushing begins. Trusting the chosen birth provider(s) is a great way to lower risk all around

Finding a birth doula

• What is a birth doula? A birth doula is an advocate and educator that helps individuals better understand the birthing process and all that it entails. They are not midwives, and do not have the scope to monitor or catch a birthing baby. 

• Doula scope of practice can be found here 

• Doula ethics and code of conduct can be found here

Genetic screening

• • What - Genetic screening is for people worried about what genetic conditions their blood might carry

    • A few of the things screened for are: 

      • Cystic fibrosis

      • Fragile X syndrome

      • Sickle cell disease

      • Tay-Sachs disease

      • Huntington’s disease

      • Spinal muscular atrophy

      • RH Sensitivity

  • When - Typically completed pre-conception 

  • How - Most screening is done through blood work 

Ultrasound

• • What - An ultrasound, or sonogram, is an imaging technique that uses sound waves to produce images of a fetus in the uterus. Fetal ultrasound images can help your health care provider evaluate your baby's growth and development and monitor your pregnancy, as well as to better date conception to avoid being induced for post term pregnancy as well as hysteria around a falsely deemed premature baby

  • When - When there appears to be complications, or if the pregnancy is likely to be high risk, providers may need an ultrasound at 6 weeks. For less complicated pregnancies, the first ultrasound is often 10-13 weeks. This is considered the "dating" ultrasound, where practitioners are able to see the fetus and best know how long the parent has been pregnant. At times birth parents are certain of their dates, or are paying out of pocket, parents may prefer to wait until the anatomical survey done between 18-20 weeks. This is the ultrasound where parents often learn the sex of the fetus. During the third trimester, if the pregnancy is high risk, ultrasounds might be used to confirm the positioning of the baby, as well as to check on the quantity of amniotic fluid. This is a test that, unless complications arise, birth parents may refuse depending on their practitioner

    • Occasionally people receive ultra sounds at the end of pregnancy for a variety of reasons that span from positioning of the baby, to checking in with multiples, and many other high risk situations

  • Who - Dr Thiagaraja is the most highly recommended ultrasound tech in Charlottesville

  • Risks, Research, and Local Standard of Care - Not much research has been done in regards to the risks of new ultrasound technologies. There are definitely local care providers who will refuse care, if you refuse to receive any ultrasounds. Typically, home birth CPMs and CNMs will allow this test to be refused and continue care. Information from the Mayo Clinic may be found here

Placenta Growth

• • What - The placenta is a large organ that develops during pregnancy, and is attached to the wall of the uterus, in the location of the uterus that the egg implants. The placenta filters the blood from the mother, filtering oxygen, glucose and other nutrients to your baby via the umbilical cord. 

  • When - The placenta begins growing between days 5 and 12 of pregnancy, starts circulating the fetal blood between days 17 and 22, and begins producing progesterone between weeks 8 and 12. The placenta continues to grow until the end of pregnancy, when it is released by the body after the baby has been born

  • Early Miscarriage - Progesterone is a key hormone to becoming and remaining pregnant. Around week 12, the placenta entirely takes over progesterone production, and if it is too low miscarriage may occur. It is possible, and even required to supplement progesterone during certain high risk pregnancies

  • After Birth - Placentas are created by mammals, and with humans as the exception, are typically eaten immediately after birthed from the body. Many people consume their placenta, and you can learn more about that here. Ancient Chinese medicine prepared the placenta for later use by the child, should the child become very ill. More information about the Chinese medicinal practice here

Transvaginal cerclage 

• • What - The cervix is sew up in what is called a "purse stitch", which is easily removed at the end of pregnancy, typically at 37 weeks, in preparation for vaginal birth. 

  • When - This procedure is done in rare instances of high risk pregnancies where repeated miscarriages have occured due to the pregnant person's cervix opening too early, causing miscarriage.  When it is used, the stitches are typically put in between 12 and 14 weeks of pregnancy

Chorionic Villus Sampling

• • What - Chorionic villus sampling (CVS) is a prenatal test in which a sample of chorionic villi is removed from the placenta for testing. The sample can be taken through the cervix (transcervical) or the abdominal wall (transabdominal)

  • When, Why, How - Done as early as 10 weeks, though usually done between 11 and 14 weeks, this test is used to discover potential chromosomal conditions, or to identify specific genetic conditions that may run in the genes. To extract the cells, a needle long enough to go either through your cervix, or your abdominal wall is used and typically 15-25 mg of CV is taken. 

  • Contraindications -  An active cervical or vaginal infection, such as herpes, vaginal bleeding or spotting in the previous two weeks, high risk of miscarriage, an inaccessible placenta due to a tilted uterus, or noncancerous growths in your cervix or the lower part of your uterus. 

  • Risks - Miscarriage, Infection, and RH sensitization

    • To learn about medications to avoid RH sensitization, jump to the bottom of this list to RhoGAM

    • Research - Articles from NIH can be found here

Fetal Monitoring

• • What - This will happen at every prenatal visit beyond 6 weeks, and is often done with a fetal doppler, which is a handheld device that uses sound to detect the fetus' heart rate.  This can also be done with a pinard for folks who prefer not to use electronic sound monitoring for religious or personal reasons 

  •  When - Along with every prenatal visit, care providers may use handheld devices, as well as belts during labor, and less frequently these days, a pinard. Most pregnant people prefer the handheld devices, as the belts often limit movement, can give false readings when not places correctly, and move frequently on the body 

  • Local Standard of Care - All home birth midwives in the Charlottesville area use handheld fetal dopplers, and unless specifically requested, people in labor can expect to be put on the belt monitors 

Glucose Testing

• • What - There are several types of glucose tests that a pregnant person might encounter. Ultimately these tests are trying to detect whether or not the pregnant person has Gestational Diabetes (GDM)

    • Glucose Screening - A screening test for the potential of gestational diabetes that measures your blood sugar 1 hour after eating 50-g of sugar or glucose syrup. If your blood sugar reads higher than 130 an hour later, more testing should be done

      • Eat and drink normally for the days leading up to the test. Avoid eating much more than 5 hours before the test, if your appointment is midday or later. If your appointment is in the morning, either fast or eat early enough that the food won't interfere with the test. If you do need to eat, focus on eating mostly protein that day

    • 2 Hour Glucose Tolerance Test - A blood test that requires fasting beforehand, you will be given 75g of sugar or glucose syrup. Your blood will be taken at 1 hour and at the 2nd hour. If your readings remain high, the third test will be scheduled. 

      • Eat and drink normally for the days leading up to the test, but do not eat or drink anything sooner than 8 hours before this test 

    • 3 Hour Glucose Tolerance Test - A fasting blood test that requires consuming 100g of sugar or syrup, and takes blood sugar levels at every hour

    • Diagnosing Gestational Diabetes - An article about what GDM is, Risk Factors, Description of what the tests are, and how to take them, and the benefits of knowing whether or not you have GDM

  • Risks - If you're on medications, let the practitioner know before hand. Some medications alter blood sugar and will cause false readings. There is little risk to the fetus, or the pregnant person if they are not already diabetic, aside from potentially being allergic to the sugar substance consumed, or from passing out due to low blood sugar.  For people with type 2 diabetes, hypoglycemia, or any other blood sugar based condition, the risk for fainting is higher. In a small population, there may be a risk of vomiting or other fasting and needle related reactions

  • Standard of Care -  This is one of those tests that many practitioners require pregnant people to complete, in order to remain in-practice. Midwives that allow for people to refuse testing might require a food journal and daily blood sugar measurements

Heart Burn

• • • What - a form of indigestion felt as a burning sensation in the chest, caused by acid regurgitation into the esophagus.

    • When - The more pregnant you become, the more likely you are to experience heart burn. Stomaches are open at the top, they have a sphincter with a flap over it to keep the food in, but as the fetus grows, that opening becomes larger. 

    • How - To help deal with the pain try using a alkaline food, like yogurt, to cover the food you've just consumed. Try not to eat a few hours before bed, and when you lay down, prop yourself up if heartburn becomes an issue only when you lay down 

Vericose Veins

• • • What - Varicose veins (or spider veins) are swollen, sometimes twisted veins that you can see just under the skin. They can be very painful

    • Why - There is weakness in the walls of the veins that turn into vericose veins. Due to gravity, and the increased pressure within veins due to pregnancy, as well as the physical blockage of fluid movement due to pressure of the growing fetus, this condition becomes far more likely with pregnancy

    • How - Wearing compression socks and putting your feet above your heart can help keep this from occuring, and or it can lessen the pain once vericose veins occur

Group B Strep Culture

• • What - Group B Streptococcus is a bacteria that all humans have in our intestines. Due to proximity to the rectum, Group B Strep can be found colonizing in some vaginal canals. 

  • How - Swabbing around the vagina and right inside the vaginal canal

  • Why - Colonization does not guarantee that an infection will occur, but in the very rare case that and infection occurs, brain damage, premature birth, and death could occur in newborns

  • Treatment - If you find out you are colonized with Group B Strep, you can change your diet to alter your vaginal PH, and at times that can kill of the colonization with retesting. Taking antibiotics during labor is another treatment option.  This treatment is not specifically researched or evidence based. 

  • Article - An (unfortunately gendered) article can be found Here. It discusses how low the risk of infection is 

  •  Standard of Practice - This is another test that most in hospital providers require to remain with their practice as a patient. If you should refuse this test with a midwife, know that if transport to a hospital is required for your newborn, they may demand anything from several observational days, to a spinal tap to prove your child does not have an infection, neither of which are evidence based to be able to tell when infection is present, due to the obvious symptoms that are specific to Group B Strep

Non Stress Test

• • What & Why - At the end of the third trimester, there are times when you or a provider may want to check the response health of the baby. Some of the things that may draw a provider to recommend a non stress test could be a trauma occured to the parent, the pregnancy may involve multiples, the baby isn't moving as often or at all, or it could just be a test that your provider requests of every patient they work with once the due date is past

  • How - Before the test, the practioner will take the blood pressure of the pregnant person; the blood pressure will continue to be taken at intervals during the test as they lie back comfortably. While blood pressure is being taken, the fetal heart rate will also be recorded at regular intervals. The care provider may have patients drink some juice, or eat something sugary, to see the response in the baby 

  • Risk - There is no risk to the pregnant person, or to the baby during a non stress test 

Biophysical profile

• • What - The biophysical profile is a test done after the 28th week of pregnancy. It is a noninvasive test used as a diagnostic tool and to help evaluate the fetus 

  • How - The biophysical profile measures body movement, muscle tone, breathing movement and amniotic fluid volume around the fetus using ultra sound and a non stress test 

  • Risk - There is no risk to the pregnant person, or the baby during this test

Contraction Stress test

• • What -This test uses ultrasound and fetal monitoring to determin if the fetus is able to withstand contractions. 

  • How - This test requires contractions to be stimulated, often using either nipple stimulation or a pitocin drip. 

  • When - Often only done in high risk pregnancies 

Prodromal Labor 

• • What - Often called Braxton-Hix contractions, are an often misunderstood experience during pregnancy, or the beginning of labor, I like to consider this the end of pregnancy. Prodromal labor is what it's called when prolonged contractions occur, without an increase in intensity. Many people describe the experience like that of really intense menstrual cramps.

  • When - Comes when most relaxed, often at night. Typically lessens during the day, when away from home, or when high stress comes up. These contractions happen more often for those who have previously given birth, and may occur longer for those without strong stomach muscles. 

  • Why - Many care providers consider prodromal labor a form of "push ups" for the uterus. They've been described as the warm up of instruments in an orchestra; the body isn't ready for the opening song, but instead needs to make sure everything is in tune

Pelvic exams

• • What - An exam where the care provider inserts their fingers into the vagina, and feels the cervix for any opening of softening that occurs before and during labor

  • How - Pelvic exams are fully refusable in all non emergent situations, despite many labor teams using phrasing that implies other wise. 

Why - Pelvic exams are utilized for many things, a few reasons they are used are to learn if the pregnant person's cervix is opening, learn if there is a cervical lip during pushing, and to feel where baby's head is within the birth canal

Active Labor

• • What - Active labor doesn’t occur until after the cervix has grown to 4+cm and intensity of labor is steadily increasing

  • More - Transition occurs when the cervix reaches 10 cm

    • In unmedicated, undisturbed birth there is often a reduction of contractions during a short rest period that can last up to an hour before the fetal ejection reflext kicks in 

The Fetal Ejection Reflex

• • What - A physiological reflex the upper uterine segment begins contracting downward, assisting to push the baby out 

  • When - The Fetal Ejection Reflex kicks in after the transition portion of active labor

    • This is how people in comas are able to non surgically give birth. 

  • Research - National Institute of Health's article on the imporatance of privacy in labor here

Birth Preferences and Emergency Plan

RhoGAM

• • What - In the case of the pregnant person having a blood type with negative RH, and if the baby has a RH positive blood type, RhoGAM is used to stops your blood from making antibodies that attack Rh-positive blood cells, which can result in terrible results in future pregnancies

    • Rhesus (Rh) factor is an inherited protein found on the surface of red blood cells. If your blood has the protein, you're Rh positive. If your blood lacks the protein, you're Rh negative. Rh positive is the most common blood type. Examples of blood types are: AB+, B, O+, etc

Vitamin K

• • Research - Evidence on the Vitamin K Shot in Newborns

  • What - Vitamin K is a nutrient that causes clotting of the blood. Though humans are born without it, by day 8 most babies have the correct amount for their size. 

  • When - given to newborns as a shot either within the first 24 hours of being born, or orally per the directions on the specific supplement being used. 

  • Why - Some babies are born with a clotting disorder that can be dangerous. Because the disorders are carried in recessive genes, there are higher rates of these disorders when both parents have the traits. 

  • How - The Vitamin K shot is given in the meat of the thigh, and the oral Vitamin K is rubbed on the new born’s gums 

  • Standard of Care - Central Virginia's standard of care is to give newborns a shot of Vitamin K within the first 24 hours. This is especially important if a child is being circumcised before day 8. 

Erythromycin

• • What - One of a few antibiotics used to prevent eye infection in newborns immediately after birth

  • Why - It is federal law, and central Virginia Standard of Care to offer these antibiotics. The law is and old one meant for a time before there was a cure for Chlamydia and Gonorrhea. Now many medical websites recommend it to avoid pink eye 

  • Risks - According to Contemporary Pediatrics, "Parents who decline eye ointment typically express concern for eye irritation, lack of perceived risk, or interfering with parent-child bonding because of blurring of the infant's vision...erythromycin ointment can cause chemical conjunctivitis"

  • Research - A professional article linking to research 

Hepatitis B Vaccine

• • What - Hepatitis B vaccine is a vaccine that prevents hepatitis B. Hepatitis B is a virus that is contracted through blood, semen, and other mucosa exchange

  • How - The first dose is recommended within 24 hours of birth, though it can be given any time before sex occurs, or needle drugs are used. Typically, two doses given after that; in cases of HIV or low immune response, a third dose is recommended

 Circumcision 

• • What - The removal of either the foreskin from the head of the penis, or the clitoral hood from the clitoris

  • Why - Often, though not always a decision based on religious tradition, or for cosmetic assimilation

  • Risks: A Standford article on the risks of circumcision here

  • A New York Times article about Jewish parents that decide not to circumsize here