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Maternal Death and the United States {Birth Without Fear}

Maternal Death and the United States {Birth Without Fear}

Maternal Death – the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes. (WHO)

This is a subject no one really wants to talk about. Mothers die. Mothers die in pregnancy and childbirth and just after birth. The weight of that reality is just so heavy and heart breaking. In our current birth culture, fear reigns. However, fear reigns without reason or knowledge of what really needs fear. And of course – all of us hope to Birth Without Fear. And so, I approach this subject with a heavy heart but hope as well.

Samantha's Birth

Where Does It Happen?

In short, it happens everywhere. However, some areas are more prone than others. This can be due to lack of care – think of sub-Saharan Africa or rural villages in some undeveloped countries. Maternal death in those areas is an unfortunate fact of life (though organizations are striving to change this).

But apart from the “obvious” places, where do you suppose it happens? Perhaps war-stricken places, or those places without advanced medical facilities? Would it surprise you to know that the United States has one of the highest maternal mortality rates in the developed world?

Yes – you read that right. Our current maternal mortality rate is 21 deaths per 100,000 live births as of 2010 (WHO). This rate went up from 2005 (18/100,000). The 2010 “Healthy People” Goal for the United States was set at 4.3/100,000 – we grievously missed that by a large margin. The 2020 goal is 11.4/100,000, which would only be a 10% decrease from what the US considers to be its current statistic (the 12.7/100,000). I find it interesting that the government decided after they missed the 2010 goal that maybe they should try less to save mothers, since their efforts before had no effect and saw a rise in deaths.

The WHO number is adjusted from the number reported by the CDC (12.7/100,000) – this is because the United States does not have a universal system of reporting maternal deaths and the CDC admits that our numbers are drastically under reported due to this lack of uniformity in reporting (See this CDC publication, specifically page 20). Currently, only 25 states make it mandatory to state that a death was pregnancy related on the death certificate – and even this method is questionable due to lack of doctor training in filling out certificates and the great fear of litigation in the medical system. Ina May Gaskin writes about the lack of reporting here.

Other countries have much better standards of reporting. The “gold standard” is considered to the be reporting system in place in the United Kingdom. The UK ensures that not only is every death reported, but they also compile the deaths and reasons for them in a report every three years. This report is available to the public and the locations and names of the deaths remain confidential. This allows the nation and the nation’s health workers to look at the issues without fear of litigation – meaning they have no reason to hide maternal deaths.

To provide some perspective, here are the rates of some other countries:

  • Australia: 7/100,000
  • Brazil: 56/100,000
  • Denmark: 12/100,000
  • Germany: 7/100,000
  • Israel: 7/100,000
  • Japan: 5/100,000
  • Netherlands: 6/100,000 – note that about 30% of all births here are at home.
  • United Kingdom: 12/100,000

As you can see, we are rather behind many other countries – and don’t worry, I am going to come back to Brazil and why I included that statistic which is very high for an industrialized country (as is the USA’s number).

Why Are Mothers Dying?

This question is hard to answer since as mentioned above the reporting methods are varied and not always followed. We do know that some deaths are simply not preventable, this is just a fact of life. However, looking at the much lower numbers in other comparable nations we know that unpreventable deaths are not the reason for the very high numbers in the United States.

We know that it is not from lack of care in general – reports show that over 99% of all women in the United States receive prenatal care. However, we have to look at the level of care women are receiving. We have to ask, does a 5 minute rushed visit with your actual doctor count as adequate care? Does more diagnostic testing equal better care? Does spending more money equal quality care? (The numbers say no – we spend more than any other country in the world on birth).

We see a HUGE disparity in death rates in regards to ethnicity. An African-American woman is 3.3 times more likely to die in childbirth than a white woman. This is simply not acceptable in a country as advanced as ours, and one that is supposedly equal. Midwives such as Jennie Joseph are helping to implement ways to combat this disparity – her creation of The JJ Way is an example of how we can work to correct this travesty.

A big question that needs to be asked in the United States has to do with who is providing this care – care that is obviously not saving as many mothers as it should. In the United States women overwhelmingly see Obstetricians. While Obstetricians are amazing for complicated and high-risk pregnancies, they don’t have much training in plain old boring pregnancy and birth.

A majority of the time pregnancy will proceed in a normal fashion, and birth will follow in the normal fashion. When we use care providers who are trained to search for problems there tends to be a trend of finding problems whether they exist or not, or whether they are actually emergencies or not. As the saying goes, “Give a boy a hammer and he will find something which needs to be hammered.”

We can see that in countries were the majority of care is given by midwives (or that country’s equivalent care provider) the maternal mortality rate is lower (and the infant mortality rate is lower as well). The United Kingdom is a great example of this. They are comparable to us in many ways (general health and population structure), and yet consistently have better maternal outcomes. And they use the midwife model of care in which all women start with midwives and only transfer if problems arise. (Note that a woman can opt for an OB to start with, however most do not).

Now for the elephant in the room: the United States cesarean rate. Our current cesarean rate is 32.8% (CDC). Yes – basically 1/3 of all babies in the US are born through cesarean. So are 1/3 of all US women somehow “broken”? Unable to birth? Producing massive or stubborn babies? NO – of course not. If 1/3 of all women in the US were “broken” then those numbers would be reflected all over the world, and the statistics show this is not the case. In the same vein, we are not producing massive babies either – in fact the average birth weight has gone down as the cesarean rates have gone up (and is independent of that rise or that of induction).

Remember when I said I would come back to why I included Brazil? Brazil has a rather good medical system and is considered a developed country, so why the massive maternal death rate (56/100,000)? Take a look at their cesarean rate – 52.3%. Yes – over 50%. Brazil is an interesting case since most of these surgeries are elective, even for the first time mothers. The fear of childbirth is so deeply engrained in Brazilian culture that women jump at the opportunity to have a cesarean and avoid labor totally. A vaginal birth is seen, culturally, as something only poor women do because they can not afford a cesarean.

That mortality rate could be the United States’ future. We see a fear of birth in the US, and a huge cultural love of telling horror stories about labor and birth. We see more interest in elective cesareans (though elective first time cesareans are not significantly altering the rates). As VBACs are “allowed” in fewer and fewer places and malpractice issues continue to rise we see more and more women forced into surgeries they do not want or need. Our rates are heading right up to that of Brazil’s, and our maternal mortality rates will be sure to follow. A Cesarean increases the risk of death significantly in comparison to vaginal birth.

In comparison, the rate of cesarean in the UK is 25%, the Netherlands has a rate of 14%. As I stated before, the UK has 12/100,000 rate and the Netherlands 6/100,000 – rather interesting that as the rate of cesarean is almost half in the Netherlands and their rate of maternal death is also half that of the UK. While in some countries a higher cesarean rate does not correlate to a significantly higher mortality rate, those countries with very high rates of cesarean typically have higher (or rising) mortality rates.

We also cannot forget postnatal care. The postpartum period is one that needs care just as much as the prenatal time period. In the US, typically a woman is seen in the day or two after birth, at two weeks or so, and then at six weeks…and that is about it. This is simply not enough during this time of life when hormones are changing, the body is attempting to heal from creating another life, and things like retained placenta or clots can cause major issues. A much better plan of postpartum care must be put in place.

What Can We Do?

Be Educated. That is the number one thing you can do to not only help yourself have a safe pregnancy and birth, but also to help the women around you as well. When you learn, share the information. Break down the myths that pervade this culture – break down the assumption that VBACs are dangerous, or that “big babies” need surgical birth. Share the studies and articles you read.

Be Fearless. Help to eradicate fear of birth. Can birth end in tragedy? Yes. Unfortunately is does happen. But with proper and evidence-based care we give ourselves and our babies the best chance. Share the positive birth stories you hear. Share your positive birth. How does this help? It helps women to not fall into a fear based decision that increases her risks of complications – namely induction and cesarean. When a woman can start her pregnancy and birth journey from a positive place it gives her more space for growth and research. Absence of fear is not ignorance of risks – it is not being beholden to the fear of risk.

Those two things hand-in-hand – education and fearlessness – can go a long way towards helping this mortality rate go down. An educated woman is better able to avoid situations or care providers that increase her risks, and a fearless woman is better able to stand up for herself and decipher what is really in need of intervention and what is not without cultural fears clouding her view. Lets do our part to save mothers.

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Prepping for Your Home Birth Without Fear {The Ultimate List}

Prepping for Your Home Birth Without Fear {The Ultimate List}

One of the most common questions about homebirth from those considering it is, “What do you need?” While the list of supplies varies from midwife to midwife, there are some basic things that almost everyone is going to need to gather in preparation for the birth. There will also be things you will (probably) want to do for your comfort and peace of mind before “go time”. This is meant to be an Ultimate (I hope I thought of everything) List, but please don’t stress yourself to cover all the little extras. Birth really is pretty basic. This list is long and detailed so that you have a chance to consider everything you might want to do, not everything you have to do.

Early Prep

While not everyone plans a homebirth from the start, many women do. If you can get a head start on a few things it makes the final months much more peaceful. After you have lined up your midwife, get a head start on your prep.

One of the first things you can do is to create a peaceful space. (Right about now mothers of small children are laughing). If you know which room/area you plan to use then work in the early months to slowly declutter and create your space. Your nesting urge will come in handy with this as well.

If you have older children, you will want to decide if you want them at the birth or not. If you do there are things you can do to prep your child for the birth. Some things will depend on their age – for instance a one year old won’t need the same prep as a 5 year old. Older children may be interested in the mechanics of birth and understand more. You know your children best. Birth can be a beautiful family event if you decide to have your children there. And if you don’t think you want them there – no guilt! Everyone labors differently.

For younger children helpful prep includes books, videos, and role playing. There are a few children’s books out there that discuss homebirth, one of my favorites is called Hello Baby by Jenni Overend. It is beautifully illustrated and is great for little ones. Birth videos are also great for prepping kids. I previewed many, many homebirth videos on youtube and created a little playlist of those I thought my son could see. I included water births, “land” births, quiet moms, loud moms, and especially videos that included the whole family.

Speaking of “loud” moms – this is where the role playing comes in. While I was a very quiet laborer with my first born, I wasn’t sure if I would be again. We never know how labor will go (and I wasn’t quiet the second time, by the way). So we discussed as we watched the videos that mommy may “Roar”. I talked about roaring like a dinosaur or a lion. We had a lot of fun roaring at each other and I explained that if mommy roars it is okay – I am not hurting and it just means the baby is coming soon. Apparently this worked really well since my two year old was not phased at all by my roaring at the birth – and I was loud!

Another opportunity for prep and role play with little ones can include your midwife visits. Many homebirth midwives do home visits for prenatals or have offices that are child friendly. I made my son a little midwife kit of his own, including a little plush placenta I whipped up with some felt. During my appointments in our home he “helped” my midwife and we talked about the baby. All of this helps children feel included in this life changing event.

plush placenta

Now whether you decide to have your children at the birth or not, I highly suggest lining up a support person for them. If they are going to be taken somewhere else for the birth be sure they are comfortable at the location and with the support person. Also try to pick someone with a flexible schedule who can be “on call” for the birth.

If they are going to be staying with you for the birth then you need to pick a special person. You need to pick a person who is there just for the child/children. This means that if they need to leave the house or room and miss the birth, they will be 100% okay with that. I would suggest clearing this specifically with them, since in some cases support people at home births might be signing up in the hopes of being a spectator. This isn’t the point of a support person for the older child. Be sure to acclimate them to your routines and places they can go with your kids. Discuss car seats if they need to drive the children anywhere. While this may seem over-kill it will give peace of mind in the last weeks and while in labor. It also clears up your support team to work just for you during the birth and not have to split their attention.

You will also want to consider if you want a doula for your home birth. Be sure to set up an interview and get someone who you feel is comfortable in your home and is preferably experienced or knowledgeable about home birth. Another part of your team to consider is a birth photographer. Again, interview them and be sure they make you feel comfortable. It also helps if they understand home birth or have shot one before, since they have different highlights and flow than a hospital birth.

Almost to the Finish Line!

Once you hit about 32 weeks, order your birth kit. This may seem a bit early, but some companies take a few weeks to ship. Or, if you are lucky like me, it will get lost in the mail because apparently your house is invisible to UPS. This also gives time to clear up any issues if the order is wrong or missing something. You don’t want to be stressed at the last minute!

There are many places to order birth kits and your midwife may have a custom kit set up with a particular company. You can also order kits of your own making or a basic kit from places such a In His Hands or Baby, Birth and Beyond. *

Basic Supplies Include:

Now that is just a starter list, and as I mentioned above some midwives will want more or less or different items. Some additional items might be an herbal after bath, different herbal items (for cord care or afterpains), Depends-type underwear, and a “birth certificate” and foot printing kit. You can also take off items from a premade kit on most sites, and substitute in your own items. For instance you may get your own postpartum pads and “depends” (hey, those are handy the first day or so!). The one thing I suggest not skimping on is the chux pads. Most births require a good amount of them, and they are handy after birth too. I tend to use them for a couple months under my sheets to protect the mattress from breastmilk leaks in the night.

Once you have ordered your birth kit it gets exciting! You have all these cool things ready to go, so what do you do with them until the big day? Enter the plastic tote.

boxes

I love “totes”. Really – my house is full of these lovely plastic boxes. It makes everything look organized, even if you really just threw stuff in there eight years ago when company was coming over. But I digress. Plastic totes are perfect for organizing your birth supplies. The above picture is actually my birth supplies from my second birth. The top tote has all the little stuff. Here was my personal list:

  • Everything from the basic list above, plus a few additional items from my midwife’s list
  • Several hair ties (in a small plastic baggie, taped to the inside of the box)
  • Chapstick (in the small plastic baggie as well)
  • A roll of paper towels
  • My heating pads, both the plug-in version and my rice heat pack
  • A bath robe

The bottom tote has all the linens I would need. For the bed I had a fitted sheet and flat sheet, a plastic bed protector (I actually scored that at the dollar store), and a really old holey fitted sheet. I gathered four or five old towels I didn’t mind getting dirty or stained (none of them ended up stained) as well as several wash cloths. I also threw in a few pairs of underwear and a pair of socks. This box wasn’t so much about needing things set aside for me, it was more about having it set aside for my birth team. This way I could just say “check the tote” instead of explaining where my sock drawer was.

A note about the bed, and more experienced homebirth moms will know this already – prepare the bed whether you want to birth there or not. Labor is a funny thing and may not go the way you planned (as I found out myself!). The most convenient way to prepare the bed in my opinion is to make what I think of as a bed sandwich. When you go into labor, have your partner strip the bed. Then put on a fitted sheet and flat sheet that are clean and nice. Over this, put the plastic mattress protector (or large plastic shower curtain liner). Then over this put the crappy/holey/old fitted sheet you don’t mind messing up.

If you birth on the bed or get anything on it, you simply strip off the old sheet and protector and VOILA you have a clean and ready made bed underneath! It may sound odd but this was one of the best things after the birth was over. I ran to shower off and when I came back the bed was totally ready with minimal effort for my birth team.

Another great place to store your birth supplies for easy access is the pack-n-play or crib:

tamara birth supplies

Okay – so that is your supplies covered! That was easy.

The Last Weeks

Now there are just a few additional things you may want to do. One is a list. This list will be for your main birth partner. On this list include the steps you want them to take once labor starts. For me and my husband the list looked went something like this:

  • Call midwife (include number)
  • Call photographer (include number)
  • Call child care to give a “heads up” (include number)
  • Make bed
  • Empty washing machine
  • Hook up hose attachment for filling the birth tub, start to fill tub if in established labor

This list meant that I could concentrate on labor and not have to direct anything. I could get in “the zone”. I included the numbers on the paper just in case he couldn’t find them in my phone or his or if someone else was there doing the list instead. I didn’t include “call family” since we agreed we would not call family until the midwife had arrived and I gave the go-ahead. This was a lesson learned in our first birth that sometimes alerting family at the start of labor isn’t always the most peaceful thing to do if labor is long.

If you have a support person for your child, create a little cheat list for them of your child’s routine and favorite foods if they are not familiar with all of that. While the lists might seem over-kill, trust me that the less questions directed at you in labor the happier you will be. It also helps you avoid the little mini-panic that tends to happen in the last weeks when you realize that life is about change in a big way and you want to scream “I have no control” – yes, most pregnant mamas have been right there with you!

The next thing you will most likely want to do is a trial run on your birth tub, if you are using one. My friend and I both were very glad we did a dry run. For myself, we found out the tub had a slow leak and we created a plan for dealing with it. For my friend, she found this:

tamara tub hole

Yes – that is a giant hole. Apparently the plastic of the tub got brittle from the cold of the trunk it was stored in and it cracked. Since she looked at the tub around 36 weeks she had time to get a new tub from her midwife and do a dry run with that tub. Imagine if she had not inspected the tub until she was in labor! Doing a dry run also lets you see where you want to set it up and make space. Keep in mind you want room around the tub for your team to work and have access to you. Also figure out how you are going to fill the tub and think about how much hot water you will need. Some sinks may need an attachment to put a hose on it or may not have good water pressure. You can also fill your tub from the hot water heater or shower. If you are using your own built-in tub in your home, put some nesting skills to use and give it a good scrub down or have your partner do it (I vote for the partner).

tamara tub test

Another thing you may like to work on is affirmation cards. This would be a good activity for a quiet evening before baby comes or even as part of a baby shower or mother blessing. You can hang the cards around your birth space and even put some around the house where you will see them in the coming days (like on your bathroom mirror).

One of the final things you might want to do is be sure a space is clear for your midwife. Most midwives like to lay out their supplies if they have time before the birth is imminent. This can simply be a good patch of clean counter top or space on a bed in the birth area. If your kitchen looks like mine, a clear bit of counter space may mean moving your stand mixer under the cabinet or storing the blender or clearing the kitchen table (mine always ends up as a catch all). If you don’t have time to do this (or birth catches you by surprise) don’t worry, your midwife will find a good spot. Again, remember this is the Ultimate List – not the “stress about everything” list!

krystal midwife prep

You can also take a moment to set up all your postpartum supplies in the bathroom and by your bed. Myself and another friend I know created a breastfeeding station – nursing pads, nipple butter/lanolin, a good book, children’s books and small goodies (for the older child), and a nice water bottle. Some postpartum supplies you might like are a peri-bottle, pads in easy reach, herbal preparations (like those sold by Earth Mama Angel Baby), and over the counter pain medications for after pains (or herbal preparations). Always discuss medications or herbal options with your care provider.

krystal postpartum supplies

A small note about the cleaning that needs to be done. One midwife described it to me this way: “Clean like your Mother-in-Law is coming for a visit.” Basically, clean like you are having an overnight guest and then just take some extra care in a couple key places – your birth space and the tub/shower you may want to use. There is no need to over sanitize and totally tear apart your home in preparation for a home birth, just keep clean and neat. A great investment if you have it in the budget (or have an amazing friend) is to have someone come in and do a nice deep clean around 36 or 37 weeks.

Now you have all the preparation done. You have a peaceful birth space; you have your tub ready to blow up and know how you are going to fill it. You have your support team ready and affirmation cards made. Now you can relax and focus on that moment. That sweet, sweet moment when you hold your baby for the first time. Birth Blessings mamas! Did you do anything else to prep for your home birth? Let us know in the comments!

krystal home birth

*Please note Birth Without Fear does not have an affiliation with any birth supply companies and these are only suggestions.

**Last three photos credited to Aperture Grrl Photography.

Did you do anything else to prep for your home birth? Let us know in the comments!

A Home Water Birth Based on Faith and Evidence Based Care

A Home Water Birth Based on Faith and Evidence Based Care

Around my daughter’s first birthday in December, it was placed heavily my heart to have another child. I had just graduated college, and the timing seemed perfect. My husband agreed and we found out we were expecting in January with an estimated due date of around September 17! I immediately started researching home birth midwifery options. I had an all natural, un-medicated hospital birth attended by a midwife with my daughter. I was at the hospital less than an hour before she was born, because I knew I needed to wait as long as possible before going in to be able to stick to the birth plan. It felt weird to not have a care provider with me while I was laboring. The post partum care was disappointing with my hospital midwives. So I knew I wanted to give myself something more with this baby. We deserved the best care possible. I found a homebirth Certified Nurse Midwife in my state, and she took me on as a client.

I was incredibly blessed with an easy pregnancy. I didn’t have HG this time; in fact, I never even threw up once. I was able to work out until the middle of the third trimester as well. This was such a difference than my pregnancy with my daughter, which was great because having a 1 year old and being pregnant at the same time is quite challenging! We had an anatomy scan with the maternal fetal medicine doctor that does the ultrasounds at the birth center and found out we were having a healthy son. I still tear up thinking about that day. I knew God had a plan for us to have a son, and to keep him whole and intact. He was created perfectly, and I would not change that by circumcising him! I felt instantly connected to him the moment I saw him on the screen. I knew at that moment I would do anything to protect him!

maternity shot for birth story

Having my midwife come to my house for all my appointments was so nice. I never had to make childcare arrangements for our daughter, and it was simply convenient! I also had regular chiropractic care during this pregnancy, which alleviated a lot of aches and pains. Also, I treated myself to pedicures with my girlfriends which was fun!

Once September came I had some episodes of prodromal labor. I knew my baby was getting ready to enter the world, but each time the prodromal labor would end without me actually going into labor, it was disappointing. He had been posterior most of the pregnancy, so I figured it was him trying to get into the best position.

The early morning hours of my due date, I started having contractions that I knew weren’t Braxton hicks. I knew Berkley was coming to meet us. I was timing them and getting so excited. I cleaned and lit candles, prayed and told my husband. He needed some convincing that it was time, but once he realized it was, he started blowing up the birth pool. It was around 3:30AM at this point. We called our midwife and told her we believed I was in labor. We also sent text messages to the doula and photographer. We were so excited!

birth pool for story

My midwife called around 6:00AM to let us know she was on her way. She told me my labor may stall a bit once my toddler woke up, and recommended sending her to Grandma and Grandpa’s so I could get on with my labor. In her experience, mothers of small toddlers can get out of the labor when they mother their toddler. And I was so ready, so off she went to Grandma and Grandpa’s. I remember sitting with her on the rocking chair, where I nursed her for her first year of life, telling her mommy loves her so much, and she will always be my baby girl. It was such an intense moment knowing when she would arrive back home she would be a big sister.

My midwife was right. My labor slowed way down once Faith woke up. I went almost 2 hours with no contractions. My midwife still set up all her equipment though. She suggested I take a walk, use the breast pump, take a shower, all to get things moving again. I asked for a cervical check and I was 4 centimeters dilated and 80% effaced and baby was at minus 2 station.

Hours passed with pretty minimal contractions. My midwife went to go eat some lunch around 11:00AM to give us some space. It was so weird having such irregular contractions, yet they were so intense. I was pretty confused about the situation. When my midwife arrived back, I told her I would like an intervention of some sort to get labor moving. Once my doula arrived, I consented to a stripping of the membranes. Literally, once that happened, things picked up so fast. The contractions were coming so quickly. I could barely breathe and talk through them. I noticed all my hypnobirthing techniques weren’t helping to cope. I told my husband to call the photographer, I knew it would be soon that we would be meeting our baby boy!

My midwife didn’t want me getting into the birth pool prematurely. So when I asked her if I could get in and she said yes, I knew it would be close. This was around 2:45PM. I already felt so tired from being up all night with contractions. The pool was very relaxing, I am so glad I got that thing! It was nice being able to stretch out in it. The contractions were coming so quickly. I didn’t know how much more I could handle. I felt like I was loosing it. We put on my hypnobirthing tracks which helped a little. I even said I wanted to transfer to the hospital. Looking back, I know this is a “sign post” that means that the baby is coming soon, but I couldn’t think at that point. I just didn’t know how I could handle any more labor. The photographer walked in and I couldn’t even say hi. I felt so rude! I was sobbing. I was a mess. I felt like I was failing at my peaceful birth.

janet hugging me

labor in pool 3

birth story photo 1

 

labor in pool 2

I felt nauseated (which again, usually means baby is coming SOON) so my doula did some aromatherapy which did help.  I asked to get out of the pool. I went into my room and was crying some more. My midwife came and gave me a big hug and told me I just needed a little more courage and the baby would be here. I told her she was right, that I was scared. Looking back at my photos of that moment, I realize I definitely picked the right care provider. She hugged me and told me everything I needed to hear.

laboring on ball

Right at that moment, my water broke. My midwife called her assistant in to chart the time. It was clear fluid. I felt so much better once my water broke, but then the contractions kept coming even more frequently. I started having bright red blood drip down my leg. My midwife immediately (yet calmly) figured out I was involuntarily pushing against a cervical lip. I asked if it were too late to get back in the pool. Of course not! So I ran back into the pool. The bleeding stopped just as soon as it started. Everyone was right there with me. I told my midwife I felt like I had to have a bowel movement. Again, a sign the baby is right there. She just told me “poop the baby out”, “it’s okay!”, “you can do this”.

labor in pool 4

labor in the pool 3

The pushing was an experience I had not really had before. With my daughter, she came very quickly with no pushing stage, and I had 3 first degree tears. I wanted to be in the water to minimalize tearing. It is amazing how natural it is to push. I didn’t need any directed coaching about how long to push or how to push. If given the opportunity, it comes naturally!

pushing

Within just a few minutes, he was born! I did it! I leaned against the back of the birth pool and he was right on my chest. He had vernix! He was so cute and tiny! It’s amazing how quickly you forget how tiny they are! He got a 9 and a 10 on his APGARs. He was so beautiful and calm. My photographer said when he was born, I was saying “We wanted you so much, We wanted you!”.

group shot at birth

birth of c 2

birth of C

 

after birth of c 2

I felt like I didn’t have a lot of traction sitting in the birth pool with him, so I asked to move to my bed. We went to the bed and just cuddled, hugged, breastfed, everything that should be done in that golden hour. When we were ready, my midwife checked me and I didn’t tear! She weighed our boy and he was 7 pounds 12.5 ounces and 20.5 inches long. There were no hands on him other than mine and my husbands until we consented to his exam. She didn’t even have to draw blood to test his blood type, she collected a sample from his umbilical cord! It was such a private birth, this was the experience I wanted, the experience we deserved. I know God designed me to be able to give birth, and having a midwife with so much experience and evidence-based practices made the home birth decision even more excellent. I know my fast recovery and lack of PPD can be attributed to such a peaceful birth and loving care from my midwife and family.

we did it

kale at birth

Maternity Photo by Brink Street Photography

Birth Photography by Aperture Grrl

Birth of Twins {Baby B-Birth in OR before CS}

Birth of Twins {Baby B-Birth in OR before CS}

A few days after finding out I was having twins, I began mourning the loss of my birth experience. Dramatic? Probably. But as a Doula and at the time, prospective, Childbirth Educator, and someone who’s frankly quite terrified of needles, I knew that medication, needles, scalpels and augmentation were not for me.

Coming to terms with the possibility that my birth was most likely going to be filled with things I didn’t want was very difficult. I agonized, cried and had panic attacks over it for weeks. After seeking the advice of other doulas and doing some serious soul searching, I finally started to feel peace about the possible ways I would birth these babies. However, I was very prepared to make informed decisions and fight for what I wanted and needed during my birth experience.

I knew that in order to have a birth that somewhat resembled the ideal I had envisioned, I would need to have a doctor who was ok and on board with at least some of my desires. Home birth was not an option for me so I chose a practice I was familiar with through both personal experience, and experience as a doula, who I knew would give me the best chance at a vaginal birth of twins in the area. That being said, out of the four doctors in the practice, only two were ok with the fact that I didn’t want an epidural or even want the catheter placed but only one of those two was ok with doing a breech extraction if needed, should baby B turn breech after baby A was born. While I knew I could make the decision to refuse any procedure, I also knew it was probably going to be an uphill journey and one I wasn’t sure I was strong enough to climb.

34 Weeks with twins

On the day I went into labor (around 34/35 weeks gestation), the doctor who didn’t mind if I refused the epidural but wouldn’t deliver a breech baby B was on call, but I felt at ease. We arrived at the hospital when I was 5 cm and 100% effaced. Within an hour, I had progressed to 6 cm and was hardly uncomfortable, despite the air conditioner in L&D being broken, and it being 82 degrees in my room. The rest of the labor progressed quickly, with minimal discomfort, and without any mention of pain meds, or epidurals from the nurses and the doctor.

At 9cm I was not feeling the typical transition-like contractions I had felt with my previous 2 labors and wasn’t quite sure what was happening with my body. I had prepared for something so much more intense! I had also prepared to defend my choices with the medical staff every step of the way, but none of that was necessary as they were in awe that I was completely in control of my contractions and pain management, and was willing to listen to and think about the choices I was presented with and decisions I had to make.

There were a few things I did agree to and ask for after making conscious and educated decisions, but they were MY decisions. I did ask for a bag of fluids when I arrived at the hospital, so I had an IV and I did ask for pitocin to be turned on during pushing if it was needed. Staying in the labor room to birth my babies was not an option because of hospital policy, but I was ok with that and we did move to the operating room at 9cm. Though it wasn’t a climate controlled, dimmed room, I was able to maintain my focus and feel at peace with being there.

Immediately after being checked and found “complete” I felt the urge to push, and 5 pound 13 ounce Baby A was born after a few pushes, 5 hours after arriving at the hospital.  Not one nurse counted or yelled or told me how to push, which was exactly what I had asked for.

When Baby A was born I remember thinking she was tiny and had a great cry, but I didn’t get to actually see her face. She was passed to my nurse who started checking her over, who then had to passed her to the NICU nurses because the doctor needed her help. Baby B had flipped transverse as soon as her sister was born and she did it fast too.

Everything I had read about twin births said that the worst pain you would ever feel would take place if you had to have a version during labor without an epidural. And there I was, facing a version without an epidural. When I made the decision not to have an epidural I was very much aware of the possibility of the pain but I figured I would rather endure 5-10 minutes of intense pain than all of the risks and side effects associated with an epidural through a labor.

Somewhere between both the doctor and me “talking” to Baby B and begging her to turn and the doctor and nurses beginning the version, I went into a trance like state. I didn’t feel pain, just a lot of pressure. I spent the last minutes of labor fully aware of everything that was happening, but It felt like  it was happening to someone else and I was just watching.

During the version there were about 5 hands on my belly, some holding the space where baby A had been, others turning baby B. They were able to turn her to be head down, but she then turned transverse again and her heart rate became rocky.  The doctor decided it was best to do an internal version to try to get her into position to be born. He was holding the ultrasound transducer with one hand and internally moving the baby while trying to keep her cord from prolapsing with the other. He was able to move baby B into position to be born but then she moved her hands above her head. So we sat, and waited. Waited for her to move, waited for something, anything that would allow me to push for her birth. And we waited while the doctor still was holding her cord and her in place, internally.

After roughly 13 minutes of waiting, her heart rate plummeted and wasn’t showing any signs of recovering. She needed to be born right then, but that wasn’t going to be possible to do vaginally. I will never forget the look in the doctor’s eyes when he looked at me and told me he had to do a c-section. He knew how much I didn’t want one and how hard I had fought for this birth. I knew that he didn’t want to do a cesarean and had tried everything possible to get Baby B to be born vaginally. There just weren’t any other options.

Because I had chosen not to get an epidural I was going to go under general anesthesia, which I had never been under before. The anesthesiologist who was standing by quickly started preparing the anesthesia while the nurses were racing to put sensors on my chest. The pitocin was turned off, and the room was switched from a birthing room to a fully functioning operating room in less than 45 seconds.

Right before I was put under general anesthesia, the doctor saw on the ultrasound screen that Baby B had moved her hands, and yelled for me to push. And in the confusion and haste of the OR, I pushed twice and our feisty 5 pound 8 ounce Baby B while the doctor guided her into the world, just 17 minutes after her sister was born.

I will forever be grateful to my doctor for trying so hard to give me the birth I wanted and what I needed. He respected me and my knowledge and trusted me and my body to do what it needed to do to birth these babies. Never once did he look down on or question my choices, he never made me feel like naive or pressured into anything. He went well outside his comfort zone and fought for me and fought for birth and in those 17 minutes, admittingly learned a lot.

Edited To Add:

Even though it’s been nearly seven years, the story of the birth of my twins will sometimes hit me and cause me to pause. I’ve never shared this picture before- I wasn’t ready to. I was honestly scared to. This picture captured and froze a moment so personal, and intense. The intensity and emotion are still fresh, even after all this time.

My sweet Baby B, being born into the hands of our extremely patient and incredible doctor. Her umbilical cord coming before her, after a nearly 15 minute internal version (without pain meds), seconds before I was going to be put under for a crash c-section. This moment, with our baby girl halfway between my womb, and the beginning of her life outside, before she’d even taken her first breath, was captured by my husband as he stood next to me, praying desperately for his wife and baby. He will tell you this moment defined and shaped him more than any single moment before, or since. And I don’t doubt that because it did for me too. But I can only imagine what he felt watching our baby’s birth unfold from his vantage point: the unknowns, the joy, the confusion in the chaos. Truly needing to trust, have faith, and let go.

Seven years later my perspective is changing. Instead of the uncertainty and a moment hanging in the balance, I am starting to see a joyous beginning, a triumphant entrance into the world and the perfect start to the life of our feisty Baby B.

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The birth of my twins serves as a reminder of strength and courage that I hold within. If I can get through a nearly 15 minute internal version without pain medication, I can handle almost anything. I look back on that day with peace and a sound mind, knowing it went exactly the way it was supposed to go, with nothing to regret.

GGTwins Mom

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GG Twins sleeping

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Stretch, Open, Breathe {12 Prenatal Yoga Poses To Prepare For Birth}

Stretch, Open, Breathe {12 Prenatal Yoga Poses To Prepare For Birth}

A special thank you to all of the mothers who sent in their prenatal yoga photos for this story. You are all beautifully balanced yoginis! {Guest post by Alisia}

Photos by to Cradled CreationsAmy Leist Photography, and Tammy Bradshaw Photography

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Yoga can be a wonderful and gentle way to keep your body flexible and you mind focused during pregnancy, labour and birth. Most medical and birth professionals recommend yoga as appropriate exercise – even for mums who are limited for whatever reason! Yoga poses can be modified  and a teacher can help you use props and accessories to support your body while practicing. It’s really important to remember that when it comes to yoga, “no pain, no gain” is not the motto!! The aim is not necessarily to ‘get into the poses’ or perform the perfect pose – you need to listen to your own body. It’s not a race, go slow. It’s ok to only push as far as is comfortable, or to stretch a little further to mildy uncomfortable. The aim is NOT pain!

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I personally used yoga throughout both of my pregnancies, although more with my second than my first. Regular practice enabled me to feel more open and free, flexible and aware, both physically and emotionally. I also used HypnoBirthing for my second, so yoga was a really great way to lead into my daily HypnoBirthing meditation. Even if you aren’t using HypnoBirthing, a few short stretches each day followed by a short relaxation or meditation feels great. And I don’t know about you, but for me, any excuse to relax while pregnant was welcomed by me with open arms!

I’ve put together my top 12 poses for pregnancy, which are gentle but helpful. This is not an exhaustive list of poses – there are countless other yoga positions that are great for pregnancy as well (most are, really!) – but these are the ones I personally loved the most. As always (and it goes without saying, but I’ll say it anyway!): caution should always be taken when practicing yoga while pregnant!

Easy Pose (Sukhasana)

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Easy Pose is a nice pose to start and end a yoga session. It doesn’t require a great deal of flexibility, but it can be quite intense to hold. During pregnancy and labour, this pose can be used as a rest and relax pose, and also works to gently open the hips.  Arm and shoulder stretches can be performed in this pose to relieve tension in the shoulders and open the chest. During labour, opening the chest allows deeper breathing; rest in this pose between surges and focus on the breath.

The pose: Sit on the ground, ensuring that your weight is on your sitting bones and not you tailbone. Inhale; cross your legs,  sit up (on the  sitting bones not the tailbone), stretch the spine and straighten the back. Rest your hands on your knees or thighs. If you feel discomfort, you may prefer to use a folded blanket underneath your buttocks to help you sit forward off your tailbone, or to perform this pose up against a wall to prevent slouching.

This can be a meditation position, or you can move into some back, arm, and shoulder stretches or chest openers:

  • Inhale, and reach your arms back and into a prayer position with palms together behind the back. Hold for 4-6 breaths.
  • Inhale; reach one arm up and bend it down behind the head and rest the hand on your back, at the same time reach the other arm down and around your to your lower back. Stretch your arms and shoulders and open your chest until your two hands are clasped  behind your back. Some people might have difficulty clasping hands in this position; that’s fine, just give your arms a great stretch while you try. Hold this position for 2 breaths, release the hands, swap arms and repeat.
  • Inhale, and reach your arms back. Keep them straight, reach them behind you and clasp your hands. Hold for 4-6 breaths.
  • Inhale; stretch your arms back and place your palms on the ground behind you, lengthen the spine and lean back slightly, to gently stretch the abdonmen, chest and back. Hold for 2-4 breaths.
  • Place your right hand behind your right thigh (as demonstrated in the picture above), inhale, stretch the left arm up and lean to the right side. Hold for 2 breaths, come back to centre, and repeat on the other side.

Bound Angle Pose (Badhakonasana)

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Bound Angle Pose, sometimes also called Butterfly Pose, is another hip-opener, and it also gives a nice stretch to the inner thighs, improve posture and help stretch the back and neck. Bound Angle Pose could also help stabilise the pelvis, which is helpful for many women in pregnancy. This was one of my personal favourites to labour in, while leaning over a birth ball.

The pose: Begin seated in Easy Pose, with crossed legs. Inhale; sit up on the  sitting bones (not the tailbone), stretch the spine and straighten the back. Exhale. Inhale; uncross legs, and bring your feet together in front of you, heel to heel, and draw your feet towards your groin. Press the knees towards the ground. If the knees are unable to reach the ground, gently bounce the legs – this will give a deep stretch into the thighs, hips and groin. Hold the position for 4-6 breaths. Inhale; readjust your posture – sit up, stretch the spine and straighten the back. Exhale; keep the spine straight and  bend at the hips, lean forward towards the ground. Once you have gone as far forward as possible while keeping the spine straight and without squishing your belly, bring your chin to your chest and hold the position for 1-2 breaths.

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Hero Pose (Virasana)

Hero pose looks simple, but is great for relieving leg and ankle swelling during pregnancy, improve posture, and help stretch the back, shoulders and neck. Also, as your belly grows, it can feel like you aren’t able to get a full breath, and the arm and shoulder stretches you can perform in this pose can help stretch the abdomen and open the chest to restore the breath. During labour, this pose can open the chest to allow deeper breathing, and relieve arm or shoulder tension; rest in this pose between surges and focus on the breath.

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The pose: Begin by getting into a kneeling position – thighs parallel and knees together. If this is uncomfortable on your knees, you can place a cushion or blanket between your thighs and feet, to sit on. Inhale; sit up, stretch the spine and straighten the back. Stretch the arms above the head, interlace the fingers and twist the hands so that palms are facing up. Hold for 4-6 breaths.

Arm and shoulder stretches  can be performed now:

  • Inhale, and reach your arms back and into a prayer position with palms together behind the back. Hold for 4-6 breaths.
  • Inhale; reach one arm up and bend it down behind the head and rest the hand on your back, at the same time reach the other arm down and around your to your lower back. Stretch your arms and shoulders and open your chest until your two hands are clasped behind your back. Some people might have difficulty clasping hands in this position; that’s fine, just give your arms a great stretch while you try. Hold this position for 2 breaths, release the hands, swap arms and repeat.
  • Inhale, and reach your arms back. Keep them straight, reach them behind you and clasp your hands. Hold for 4-6 breaths.

Child Pose (Balasana)

This is a relaxing resting pose that you can use during pregnancy between poses to help stretch the lower back and have a moment of stillness. In labour, Child Pose continues to be a helpful resting pose between surges, taking the pressure off your knees and wrists if you are labouring or pushing on your hands and knees. When practicing this pose, have three or four blankets stacked up ready to lean you chest on so that you can relax forward into this pose.

The pose: Inhale: position your knees apart, and sit back and gently rest on your heels.  Inhale; sit up, straighten your back and stretch your arms up above the head. Exhale. Inhale; lean forward, stretch the back and lift the tail bone, and lower the arms and head towards the ground. Have your stack of blankets ready – they should be set up in such a way that when you lean forward, your chest rest on the blankets and your abdomen is not compressed at all. Let your arms hang down beside the blanket and rest on the ground comfortably. Hold the position for however long is comfortable.

Cat and Cow Pose (Marjaryasana and Bitilasana)

During pregnancy, cat pose and cow pose are both great for lower back pain, and taking the pressure and weight of your baby and belly off your hips and back. It gives a gentle stretch for both the lower back and abdominal muscles. Practing a cat/cow sequence can also help encourage your baby to move into a ‘good’ LOA position for labour.This pose should also be on your labour ‘to do’ list, and a birth ball can be used to lean on to take the pressure of the arms and wrists. This is an especially helpful pose if your baby is posterior – it can help relieve the intensity of ‘back labour’.

The pose: Starting on hands and knees. You might prefer a towel underneath your knees, and as previously mentioned, you could lean your chest on a birth ball if you find it difficult to rest your weight on your arms and wrists. Ensure that your wrists and hands are aligned underneath your shoulders, and that your knees are positioned below your hips.  Your feet should be flexed, soles up, and your toes should not be curled under; palm of the hand should be flat on the ground and fingers should be flat and facing forward. During the poses, be aware of the pressure on your wrists and knees – weight should be equally distributed between all four limbs. Inhale; stretch your neck and lift your head forward and your chest up. Lift your tailbone and drop your belly towards the ground. Exhale; draw your belly in and up, curl your spine out, and roll your tailbone and chin down and towards one another. Repeat 4-6 times. To rest, come into Child Pose. Inhale: keeps the knees apart (or slightly wider, to accommodate your belly), and draw the hips back to rest on the heels while keeping the hands and arms outstretched, lower the head to the ground.

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A variation of Cat Pose is Extended Cat Pose (pictured above): Inhale; stretch your neck and lift your head forward and your chest up. Lift your tailbone and drop your belly towards the ground. Exhale. Inhale; shift your weight to your right leg and stretch your left leg back and up, at the same time shift your weight to your left arm and stretch your right arm forward and up. Stretch the neck and head so that you are looking forward. You can choose to hold this pose for another exhalation and inhalation, or on the next exhalation, bring the arm and leg back to their original position. Inhale, and repeat 2-4 times. Begin again, using the right leg and left arm. To rest, come into Child Pose.

Tree pose (Vrksasana)

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As you progress in pregnancy your centre of gravity changes with your growing belly. Tree Pose is a pose that help regain your balance with your new centre of gravity, as well as improving posture, and building strength and stamina for labour. Tree Pose can also work to stretch and open the hips, and can help with pain and discomfort in the hips. You may need to practice this pose while holding on to a chair, table or wall, until you develop a strong sense of balance in this pose. Always work with your body and find the right place for you – remember, the point is not how high you can force your foot to go, the point is finding your centre of balance, so even just lifting your leg off the ground is fine to start with.

The pose: Begin in Mountain Pose – standing, feet flat on the floor, with arms by your side. Inhale; stand tall, stretch the spine and straighten the back. Lift the right foot and position the sole of your foot on your left leg; some people are able to stretch the foot to the upper thigh, others need the foot lower on the calf or even just lifted in the air slightly. Exhale. Hold on to something steady if necessary, or press the palms together in prayer position: in front of the body (as shown in the picture above and below) or stretched up above the head. Stretch the spine and straighten the back. Hold this position for 4-6 breaths, lower the arms, return the foot to the ground, and repeat using the opposite leg.

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Warrior I Pose (Virabhadrasana I)

Warrior I stretches the thighs, abdomen, back and shoulders. It’s also good for balance, and it tilts and opens the pelvis, which makes is especially useful in labour during surges to encourage baby to engage.

The pose: Begin standing, in Mountain Pose – feet flat on the floor, with arms by your side. Inhale and step your left foot back so the your feet around 3 feet apart. Evenly distribute your weight between your front and back leg. Exhale; stand tall, stretch the spine, straighten the back, and place your hands on your hips. Inhale, turn your back foot 45-90o away from your body. Bend your front knee and bring your thigh parallel to the ground. Ensure that your knee does not bend further than your ankle, and that your hips and shoulders remain square towards the front. Exhale as you reach your arms above your head – let your eyes follow you hands about 3/4 of the way and settle your gaze with your head tilted slightly upwards. Alternatively, you can reach  and clasp your hands behind your back. Hold for a minute, remembering to breathe. Release your arms, straighten your leg and return to Mountain Pose. Repeat using the opposite leg.

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Warrior II Pose (Virabhadrasana II)

Warrior II gives the thighs an intense stretch, strengthens the abdominal muscles, and is extremely helpful if your experiencing tight hips. It can also help stretch the back and shoulders and relieve back aches during pregnancy. This pose can help open the hips and encourage your baby’s head to engage and in labour it can assist by opening the pelvis for baby to descend and put pressure on the cervix to aid in dilation. If you have difficulty balancing, practice this pose next to a wall.

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The pose: Begin by standing with your feet wide apart. Rotate your right leg by turning your right foot away from your body. Keep your hips facing forward in the direction of your left foot. Keep your shoulders in line with your hips, and raise your arms and look in the direction that your right foot is pointing. Bend your right leg until the knee is in line with the ankle – do not bend past that point. Be aware of your posture and do not sway your back to push your belly or hips out towards the front. Hold for 2 breaths, straighten the right leg, return to centre, and then repeat with the left leg.

Low Lunge (Anjaneyasana)

The low lunge is fantastic during pregnancy. This pose is another hip-opener, and also helps strengthen the lower back and abdomens. When practiced with arms up, it gives a deep stretch in the shoulders and back. This pose is excellent during labour, and can be helpful to hold during a surge to open the pelvis and encourage your baby to engage, rotate and descend. This can also be used during labour to encourage dilation.

This can be a really tricky pose, balance-wise. You may like to start with a blanket underneath your knee, to reduce discomfort. The picture below shows Karen (a mum of 7, soon-to-be 8, at 6 months pregnant) extending her arms above her head, and this is quite tricky. Many women need to keep their arms down and position blocks (stool, phone books, bricks etc) beside their hips so they can stretch their back and keep their balance.

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The pose: Begin on hands and knees. Inhale; bring your right leg forward and place your foot between your hands, ensuring that your knee does not extend past your ankle. If your foot does not come all the way to your hands, move your hands back and place them on either side of your right foot. Exhale. Inhale, stretch your torso up and extend your spine. You may choose to move your hands to some blocks besides your hips, or stretch them up to rest on your thighs, or reach them up above your head – this depends on your balance and level of comfort. Hold this position for 4-6 breaths, or through 2-4 surges, and then return to centre in the same way you came into the pose, and repeat the lunge using the opposite leg.

Goddess Pose (Utkatakonasana)

This is a ‘half squat’ pose that is really intense on the legs but can help build strength and stamina for labour and birth, as well as stretching the groin and opening the hips. It stretches and elongates the abdomen and allows for more room to breathe. During labour, this is another pose that can help your baby settle down into the pelvis and and put pressure on the cervix to dilate.

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The Pose: Stand with your feet slightly wider that your hips. Inhale. As you exhale, bend your knees and lower yourself so that your thighs are straight and parrallel to the ground. Keep your heels on the ground. Bring your arms up so that your upper arms are parallel to the ground and the forearms are vertical. Alternatively, you can bring the hands into prayer pose, or hold on to a chair or wall for support. Hold this pose for a few minutes.

Full Squat Pose (Malasana)

This pose is a excellent pose all round – for pregnancy, labour, and also for birthing. It takes the Goddess pose further, putting This pose opens the hips, and stretches and strengthens the legs. It can be difficult to balance in late pregnancy and during labour, so you can practice this pose against a wall for support, or use a low stool or yoga block to balance on during the squat to help you maintain the pose. If your heels lift, try placing a folded towel underneath them to lean on.

The pose: Stand with your feet slightly wider that your hips. Inhale. As you exhale, bend your knees and lower yourself so that your buttocks are only an inch or two from the ground. Keep your knees wide and your heels on the ground. Bring your hands together in a prayer position, resting your elbows on the inside of your knees to keep the apart. Lean forward slightly for balance, if necessary. Hold this pose for a few minutes.

Corpse Pose (Savasana)

Yes, that’s an unfortunate name, but a very relaxing pose! This is a great on to end your yoga session on, and it can lead into meditation, relaxation or HypnoBirthing practice.

The pose: Copse Pose is a reclining pose, laying reclined on the ground, with arms by your side and palms up. Corpse Pose should be modified into a side-lying pose after 20 weeks, so that you are lying on your right side rather than on your back. For comfort, support yourself with pillows and blankets under your head and body and, if practicing the side-lying pose, between your knees. A soft, dark cloth over your eyes will help you relax into meditation or rest.

 

Disclaimer: This is an informative article and is not intended as medical advice. Always consult your care provider about all exercise and health concerns during pregnancy. Always seek out and consult your personal yoga teacher for any prenatal yoga concerns. If you have never practiced yoga before, it would be beneficial to attend a dedicated prenatal yoga class and seek the advice of a yoga teacher before beginning practice. 

Generally accepted advice among yoga teachers is:

  • you should avoid practicing yoga in the first trimester,
  • supine (laying) poses should be modified after 19-20 weeks, to avoid compressing the superior vena cava and reducing blood flow,
  • deep abdominal stretches, crunches, and spinal twists should be avoided or performed with caution,
  • if you have any additional medical concerns (for example, Symphysis Pubis Dysfunction, Incompetent Cervix or Placenta Previa) you should seek clearance from your heath care provider before beginning any form of exercise.

There is some debate about inversions (hand, head, or shoulder stands) during pregnancy. My personal belief is that inversions come with potential risks during pregnancy due to the deep core muscles involved, the changing centre of balance during pregnancy, as well as the fall risk to inexperienced women. Most people should avoid inversions while pregnant, unless you are very experienced and comfortable with performing inversions prior to pregnancy and have a deep understanding of the safety, anatomy and physiology of pregnancy and yoga inversions. 

Many positions can and should be modified depending to your individual physical limitations. And above all else, always listen to and respect your body – if you feel pain or discomfort during your prenatal yoga practice, stop and rest. If you experience cramping, contractions, bleeding, fluid leakage, dizziness, changes in vision, pitting edema, or persistent headaches, or any other symptom that is concerning for you, contact your health care professional.

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Article written by Alisia Cameron, wife and mum of two.

My Battle With Hyperemesis Gravidarum

My Battle With Hyperemesis Gravidarum

I sit here after my son’s second birthday party with Cars cups, plates and wrapping paper all over my house. Looking over I can see pure joy in my half naked two year old sons eyes and I feel as though it is time to write his survival story down.

This is not necessarily a birth story – but the story of the 9 months prior. You see, with my 5 year old daughter (Charlotte “Charlee”) and Sebastian’s pregnancies were not the glowing, happy pregnancies that every woman wishes for. I had Hyperemesis Gravidarum (HG) for both pregnancies, and with Sebastian it was sever.

HG is severe nausea and vomiting during pregnancy and can lead to many complications to mom, baby and our external relationships with others. The typical saltine crackers and sipping Ginger Ale is not a solution to this (go ahead and suggest this to an HG suffer – I dare ya! haahaa). It is a terrible, terrible disease that makes any pregnant woman affected with it in a debilitated state and can be life threatening.

In July, Chris went to his long-weekend bachelor party out of country and I was at home with Charlee, who had just turned two in April. We had been planning on getting pregnant soon and when he got home from four days away we ‘celebrated’ and three weeks late it was confirmed – we were going to be a family of four!

At first, I believed that I couldn’t be as miserable and sick with my second blessing as I was with my first. That it wouldn’t be fair if I did, so I didn’t expect anything terrible to occur. However by the end of August (approx 6 weeks gestation) I started to get the signs I had experienced with Charlee. It was slow at first, some pretty intense nausea throughout the day which didn’t lead to vomiting but was very uncomfortable. We had our “Buck n Doe” that week and I was able to celebrate and announce our pregnancy to our family and friends.

A week later it all changed – I couldn’t get out of bed, I was vomiting 30-40 times a day (yes! That is not a typo- THIRTY to FORTY times a day). I could not keep down any food or liquid so it was mostly dry heaving with some bile. I popped blood vessels in my face and eyes. I began to loose weight quickly and had chronic constipation.

I wanted this pregnancy – I welcomed it. I did not welcome HG. It was an uninvited friend to what should have been a 9 month long party! Our wedding was coming up on September 25 and I just could not do anything to prepare for it. I went on disability leave from my job and laid in bed all day and all night only getting up to puke – most of the time I just did it in a bucket beside my bed.

My poor sweet, lovable, and perceptive 2.5 year old was feeling negative affects of it as well. All she wanted to do was play with Mommy, but I couldn’t even get out of bed without my husband’s assistance. She was so strong – stronger than I was. She made me food and tea and would bring it up to me in bed, hoping it would help me. As soon as she was gone, I would have to reach beside my bed side table and put it in a garbage bag so at least she would think she was helping me. When she would come up and check on me – I would fake that I was feeling better, that we could play dollies if we could just play them while in my bed.

This continued on for 6 months before I was starting to feel human again. Sure, I had oral anti-nausea medications and I went to the hospital weekly to get hydrated. The doctors would discharge me because I had not thrown up in the last thirty minutes and I wouldn’t even be out of the hospital parking lot begging my husband to pull over because I refused to throw up in our car. Nothing worked. NOTHING. Nothing takes away the nausea, the pain and the loneliness. The worse is the depression. Depression while being pregnant is a terrible beast that I wish no one would ever have to go through.

My depression started the second week of September. I was so sad, I couldn’t be with Charlee, I couldn’t plan my wedding, money was tight and I didn’t deserve this – two pregnancies where I couldn’t move, let alone enjoy it? Even though I never went to the doctor and told them about my depression (I just wasn’t strong enough) I figured that if the HG would let up then the depression would magically go away.

That was a great plan, if HG would have gone away. I was alone every day. Chris would get up with Charlee, take her to daycare then go to work. He would pick her up from daycare. He would make dinner. He would bath her. He would put her to bed. The only thing I was able to give my precious blonde curly haired daughter was a story before bed (of course, laying in my bed). Sometimes I feel as though I should have been strong enough. That I could have done it if I tried a little harder. But I know that in actuality I was battling something my body couldn’t handle. I felt as if I was dead, I regretted getting pregnant and on several occasions considered terminating my pregnancy so Charlee could have her mommy back. I am so glad that I didn’t consider the latter too much.

newborn baby

April 2011 came and it was a joyous month, by then we knew we were having a boy and we were over the moon. Charlee turned 3 on April 1st and I had a huge party for her (also the first time I had seen many family and friends since our wedding in September). It is one of my best memories. She was thrilled, I was relatively healthy and my family was all together again. Sebastian’s due date finally came and nothing – 9 days later I was induced. It wasn’t the way I pictured my birthing experience, but when you have such a terrible pregnancy experience giving birth is the only way to get it to end. I only required the cervix cream to jump start my labor and 9 hours later at 6pm on April 20, 2011 my beautiful 10 pounds 5 ounces 21 inches long co-survivor arrived. He was perfect from his first breath and is still perfect to this breath.

hyperemesis gravidarum

Hyperemesis Gravidarum may have ruined my pregnancy for me but that little chunky baby was worth it all in the end. I survived HG. Sebastian survived HG. Charlee survived HG (twice!). Chris survived HG (twice). We did it together.

To all my fellow HG survivors and sufferers please remember that it will end soon enough. And you will get that amazing and shiny reward at the end. You can survive this!

With much love,
The Osburns

For more information on HG please visit – http://www.helpher.org/

Pregnancy After An Eating Disorder

Pregnancy After An Eating Disorder

I have tried to write this at least a dozen times. It never turns out the way I want. In the beginning I tried to approach it like an informative article, a place people could go to find facts, research and information… but I get caught up in my own experience, and it ends up a jumbled mess… No, I can’t write an informative article. Not yet. Not until I tell my story…

So here it is. I had anorexia for over 7 years. ‘Had’ anorexia is the right way to write it, but the reality is that it had me…

I was 13 when it ‘started’. It was slow; an incessant nag in the back of my mind, slowly wearing me down, like the way a constant water drip smashes into concrete, slowly working a hole through… you’re not good enough, that’s not good enough, you’re not good enough, do it better… like a drip, these thoughts came, slowly, until they wore me down. Eventually I was swimming in them. Or more accurately, drowning in them. Everything was so out of my control, I had no idea where these thoughts were coming from, but they were inside me and they would not stop. Food became the thing I could control. While everything seemed crazy, and out of my control, I could control food. And my weight. Except, of course, that I had lost all control. I was completely and utterly powerless against this disorder.

[2003 – 17 years old: after I was discharged from a hospital stay, and when I graduated from high school]

teenage anorexia

At my worst, I was 39kg (85lbs), and at 156cm (5’2”), and this was a devastating weight to be. I couldn’t see it though. Even at 39kg, I could see extra weight; bulges and bumps that I needed to lose to be better. I lived with other anorexic girls on my many hospital admissions, and felt obese compared to their emaciated figures. Eating disorders are bizarre like that; I never could see myself for what I truly was. I saw these girls and I thought I was not controlling my food enough. Even though at one point I existed on a handful of oats soaked in water (but never cooked, because I wanted my body to burn my energy digesting them) and drinking iced water (because I wanted my body to burn more energy to warm it back up to body temperature). I wondered why my parents worried so much, I was frustrated and angry at people trying to ‘help’, and every single time I walked into the ‘Eating Disorders Clinic’ I felt like a fraud.

Thankfully, after years of suffering, I was given the help I needed and eventually I was ‘weight restored’ to 54kg, and ‘recovered’. Which is a misleading word which just means that you aren’t drowning in self-hatred – but it doesn’t mean that the drip isn’t there, or even the occasional downpour or flash flood of thoughts. My experience with  recovery from anorexia is similar to an alcoholics experience with recovery – we can triumph over it, but never let our guards down and we must always be aware of triggers. I have many triggers, but my biggest trigger was yet to come… but it wasn’t pregnancy.

I met my partner in 2006, and began trying to start a family in 2007. I always wanted to have children, and was excited about being pregnant. But I was nervous. My body was going to grow, in a way that I had absolutely no control over. I would have to surrender control, but keep control. I could not allow myself to be swept away in a flood of thoughts. I could not skip meals. I could not run until my muscles were burning. I had to look after myself, and I had to look after my baby. Could I do it? I was strong, but was I that strong? I was recovered, but… was I *that* recovered? Was I ready? Would I ever be ready?

I was lucky that physically, the years of disordered eating and being malnourished did not affect my fertility or my ability to sustain a pregnancy, although that isn’t the case for everyone.

My first pregnancy came with a wonderful sense of ease; in relation to the eating disorder at least. This was surprising, as I was always acutely self-conscious and self-critical pre-pregnancy, but my growing belly was something I cherished. For once my body was meant to be growing, and I let it grow. I was relaxed. I loved the life and energy flowing from me. I loved that eating was ‘for the baby’, and I could argue with the thoughts in my head. “I must eat”, I would think, “I must eat, for the baby”. And I did. I gained a lot of weight, and I didn’t let myself worry about it. I knew that if I acknowledged the amount of weight I had gained, it would rain-pour-flood, and I would drown. And I could not let that happen. I gained a lot of weight – over 20kg (44lb). Part of this weight gain was because I couldn’t restrict what I ate – if I did, it would just begin a barrage of thoughts that I might not have been able to fight. Another part of this weight gain was like me saying a big f**k you to the thoughts – kind of like, “you’ve controlled me for long enough, look what I am doing now”.

Unfortunately, throughout my first pregnancy I suffered with antenatal depression that extended into postnatal depression and anxiety, mixed in with some PTSD. I was lucky that they eating disorder did not take hold in a negative way. I know that many women react to pregnancy differently – the changes in hormones and body shape can be a huge trigger for eating disordered thoughts and behaviours – and even after recovery they have trouble keeping the thoughts and behaviours at bay. Women need to be aware of their strengths and their limitations when it comes to their recovery, always inform care providers and try to let people know or ask for help when they are struggling.

I birthed my daughter via cesarean in August 2008. It was an emergency cesarean; very unplanned, and very unwanted. Because I had gained so much weight, I did not just ‘bounce back’ to my pre-pregnancy weight. Well, I don’t think many women do just ‘bounce back’, but regardless, I was devastated. My belly is covered in stretch marks, my stomach shrunk down after the cesarean my skin crumpled in a sea of raw pink lines and I had a ‘hang’ on one side of the scar. I was carrying extra weight across my whole body, and I felt like a disgusting puffy crumpled-up mess. Breastfeeding did NOT help me lose weight, despite the belief that it does, and I was wearing maternity clothes for some months while I struggled with whether I would ever get to wear my pre-pregnancy clothes again.

[2009]

mother and daughter after eating disorder

I develop severe postnatal depression and anxiety. Even though I had dealt with depression and anxiety for years, I couldn’t recognise how much I needed help. I struggled, and I had a baby who existed on 2 hour blocks of sleep (if I was lucky!) and constant feeding. I was a mess, and some days were so dark I could barely see a way out. I dealt with it for years, and I fought so hard for the first two years to not relapse or go back into disordered eating. The thoughts were there, and they were strong , and I believed each and every thought that entered my head: they would be better off without you, they don’t need you, you’re nothing, you’re nothing, you’re a bad mother and your daughter knows it… For two years I fought those thoughts, but eventually I was worn.

[August 2010]

mother and baby recovery from anorexia

It was around the end of 2010 when it started again. I don’t really remember it well, but it was a tough time for us all. A multitude of things tumbled together and crashed into me and knocked me off my feet…  I lost all the weight I was carrying, and was back down to me pre-pregnancy weight. I pushed myself to my limits, all the while believing that it was never enough, I was never enough, I could do enough, be good enough, smart enough, strong enough… People told me I was losing weight but I couldn’t see it of course. Each morning I would get up, and cry as I made my coffee, then sob as I said goodbye to my daughter. I’d cry as I drove to work. On the drive to work, I’d pass cars and powerpoles, I’d drive over bridges, I’d take careless risks through roundabouts and traffic lights, wondering if I could just accelerate, lose control, drive into or drive off at the right moment, and it would all be over. I didn’t, of course, and it was probably because I knew I didn’t want to die, but I told myself I wasn’t strong enough, I was too weak, and for being too weak I deserved to keep living in hell. I usually held it together at work, and I’d come home and be angry, and cry myself to sleep.

My partner would be there, sometimes frustrated and angry, sometimes caring, but always there. Despite that, I felt alone. And so powerless and weak. And ashamed that I had let it take me again. And hopeless. She watched as I fell into a pit of despair. I pushed her away, but she stayed anyway. There was one night when she sat down next to me, with a look I’ll never forget, it was fear, she looked at me with fear. She asked me if I was going to be ok, and it broke my heart. She sobbed, and we cried together. She said I needed help. She wanted to help. She didn’t want to lose me. I told her I was strong. I could do this.

I fought and gained some control back. It was hard, but we did it together, my partner and I. She reached in and helped me out again.

[January 2012]

mother and daughter

I was pregnant with our second daughter early 2012.

This pregnancy was difficult. The first 14-15 weeks were full of vomiting and constant nausea. It was difficult to force myself to eat when I knew I would be bringing it back up in half an hour. I couldn’t work for almost 6 weeks. Things quietened down in second trimester, except for a few scares that left me in the birth suite with a fluid leak and infection.

At 28 weeks I was diagnosed with Gestational Diabetes and that was hard. I almost lost it. It was hard for me to keep hold of the eating disorder when I had to engage in the very behaviours that I were so disastrous to me for years. I had to keep track of my food, grams of carbohydrates, balance my meals, and religiously test and keep track of my blood sugar levels and weight. I had to keep it all in check. The obsessive part of me broke out, and I counted carbs to a key. I got to a point where I was 34 weeks pregnant, 62kg (136lb) and I wasn’t gaining weight and it was difficult. In my first pregnancy I found it easy to let my body gain the weight, I let myself eat, and I didn’t let myself think about it. This time, I was surrounded by triggers, and I couldn’t just ignore it, I couldn’t just eat, like in my first pregnancy. I had an acute awareness of my food, the nutritional value of my food, my weight… 

The hardest part was admitting it. I don’t like admitting when there’s something out of my control, I like being able to just take care of myself, and I won’t ask for help. Even when asked, I won’t admit I’m struggling. So telling my partner was tough. She already knew, of course. She knows my triggers, she knew what was happening in my head. We worked through it together, with a lot of support from her. I had a VBAC in November 2012, and with it, I gained a new sense of worth, achievement, and power. 

For me, the hardest part of this whole journey through pregnancy after eating disorders is relinquishing control. Through the years I lived with anorexia, I tried to control, I wanted control. Even through recovery, I hold on to the fact that I am controlling the eating disorder, I am in control of myself. But there’s an element to pregnancy and birth and postpartum that is uncontrollable. It is about trust and faith, it is about letting go and embracing the chaos. It is a fine balance between letting go and riding the wave, but knowing when to hold on again so I don’t start drowning. Even now, I struggle with knowing when I need to be in control and when I need to let go. Having a good support team around me to remind me to hold on or let go is essential.

It was also hard to get used to my new body. Things changed. A lot. Even being back to pre-pregnancy weight I am not the same as I once was. I’m softer and squishier, and I never expected that. And oh the stretch marks, so many stretch marks everywhere. No one told me my thighs would get stretchmarks, and yet as my hips widened, they did! My breasts are marked as well. And as my body shrunk back down my skin did not follow, and there is loose skin and dimples and crinkles… And I am one of the ones who don’t lose weight while breastfeeding, so that was a little disappointing as well!


post partum belly

I am 4 months postpartum now, and things seem clearer second time around. I am more confident, and I like my body. Some days I love my body. I know it deserves to be loved all the time, and I do my best. I am happier. Brighter. I still struggle with control – hold on, let go, hold on, let go…? The thoughts are there, although I wish I could say they weren’t, and they get to me sometimes. I can’t see this as something I will ever ‘get over’. Every now and then the thoughts get quieter and I live more freely, and sometimes they are deafening, and every minute is a struggle. I have to be aware of my triggers. We don’t own scales, and I don’t think there will ever be a time where I can have a set of scales in the house full-time – I can barely walk past scales on the shelf at a department store without wanting to stand on it. I can say with confidence that I will never be able to ‘diet’ or engage in any kind of radical detox program without having to fights the thoughts to take “one step further”, which is the path the leads to disordered eating. Exercise is difficult – I love running but have a tendency to push myself too far. I joined a gym once, a few months into an attempt at recovery, in an attempt to exercise in moderate and be ‘healthy’, but that didn’t end well.

But right now I am strong, and I am ok.

Written by Alisia, wife and mum to two kids in Australia.

post partum belly and baby

I Am Strong {Young Mom with Hyperemesis Gravidarum}

I Am Strong {Young Mom with Hyperemesis Gravidarum}

This is daily living for me.

I’m currently 7 months pregnant, 19 and proud to soon be a mommy. My fiancé and I found out very early on this wasn’t going to be an easy pregnancy . When I was barely 6 weeks along the complications started coming and I was diagnosed with HG. Which is short for hyperemesis gravidarum. I went from 97lbs to 82 in a few weeks. I couldn’t eat, be in light, smell, be in heat, or tolerate any sort of stimulation without becoming sick.

Around my fifth month of pregnancy I had to get a picc line in my arm; it’s a long flexible tube that goes into my arm and drains near the heart. I had to have all my meds and fluids and nutrients through the picc daily.

I’m strong because even through all of this I’m still going and I’ve never regretted anything. Never became resentful. Never loved my child less.

New New2

The Truth About Gestational Diabetes {And Why It’s Not Your Fault!}

The Truth About Gestational Diabetes {And Why It’s Not Your Fault!}

So you’ve had the Glucose Tolerance Test, or maybe you’ve been monitoring you’re blood sugar levels at home, and your blood sugar readings were high. You have been given a diagnosis of Gestational Diabetes. If your experience was anything like mine, an Obstetrician or midwife gave you a pamphlet on ‘Diabetes and Pregnancy’, referred you to a dietician and endocrinologist for management, and then sent on your way. And now you’re at home, and all the questions you didn’t think to ask are flooding in…  What the heck is it? And what does it mean? Will my baby be alright? Do I need a caesarean? Will I need to be on insulin? What can I eat? Do I have to stop eating CHOCOLATE?!?!?!

There is some debate against the use of routine testing to diagnose Gestational Diabetes, and also questioning about giving the diagnosis of Gestational Diabetes as a label on pregnant women. Dr. Sarah Buckley recommends avoiding routine testing for Gestational Diabetes for most women. Henci Goer and Dr Michael Odent are among many pregnancy and childbirth professionals who argue against diagnosing women with gestational diabetes, citing unnecessary stress and interventions as one of the risks of the Gestational Diabetes diagnosis. Nevertheless, whether you want to call it Gestational Diabetes or Pregnancy-Induced Insulin Resistance, or just high blood sugar levels in pregnancy, some women do have elevated blood sugar levels and need some extra help.

Gestational Diabetes Mellitus (GDM or GD) is described as a form of diabetes that develops during pregnancy, and usually goes away 4-6 weeks postpartum. In a pregnant woman without Gestational Diabetes, the body works ‘as usual’. You eat, your stomach breaks down your food, you start to digest it, and the glucose from the carbohydrates in your food enters the blood stream. The pancreas gets the signal to secrete more insulin into the blood stream to help the cells absorb the glucose and convert the glucose into energy. The blood glucose level increases straight after a meal but as the glucose is absorbed from the blood and into the cells, the blood glucose levels decrease. The blood glucose readings fluctuate as normal, but remain within the ‘prescribed levels’.

In a pregnant woman with Gestational Diabetes, the cells become ‘insulin resistant’. The pancreas makes ‘the usual’ amount of insulin to enable the cells to absorb the glucose, but because the cells have become ‘resistant’ to the insulin, the amount of insulin needed increases. When the pancreas makes as much insulin as it can, and the cells continue to struggle to absorb the glucose, this is Gestational Diabetes. The blood glucose levels in a woman with GDM rise as normal after a meal, but stay elevated due to the cell’s inability to absorb the glucose.

diabetes blood sugar test

So what can you do to prevent or stop insulin resistance and GDM from developing? There seems to be this myth floating around that fit and healthy women don’t get GDM, and unfit or unhealthy women are probably going to have GDM. It’s false. In pregnancy, insulin resistance is mostly caused by an increase in pregnancy hormones (hormones produced by the placenta). The hormones are thought to reduce the effect of insulin on the cell, as well as reducing the response of the cell to insulin. While keeping yourself healthy can reduce your risk, there is nothing that can stop your cells developing insulin resistance from the hormones made by the placenta. Although there appear to be some risk factors which could increase the chance developing Gestational Diabetes (for example, age, ethnicity, weight, personal or family history of diabetes,  or some hormone-related conditions such as PCOS), there are many women who develop insulin resistance and GDM who do not show any risk factors. In short, you just can’t control how your cells respond to your pregnancy hormones. There is a lot of research to suggest the most pregnant women will develop some insulin resistance during the pregnancy because of the increase in pregnancy hormones, but for many women the pancreas is able to produce enough insulin to maintain stable blood sugar levels and so it does not develop into diabetes.

There is also this idea that women with GDM can control it. Women are told “You just need to keep your diabetes under control.”, like it’s just that easy. Unfortunately, no one can explain how to control a cells response to the pregnancy hormones. You can’t control Gestational Diabetes. It happens sometimes. But telling a women that she should be able to control it really put unnecessary shame and blame on mothers who are frustrated and disappointed enough as it is. So if you’ve ever said this then, please, never say it again!

You can’t control Gestational Diabetes. It happens sometimes. But there are ways to help your body deal with it. Monitoring diet and engaging in regular exercise really can be the key for women who have low-to-medium level insulin resistance. The aim of monitoring your diet is to balance the amount of carbohydrate in your meals. The general consensus from dietitians and endocrinologists seems to be that having 3 meals and 2-3 snacks per day (but please follow the advice of your personal care provider). It does make sense that it’s easier on your body if you spread out the carbohydrates into 3 balanced meals and 2-3 snacks instead of packing them into three carb-heavy meals per day. Another way to manage high blood sugar levels can be regular exercise, like walking. Going for a walk 30 and 90 minutes after eating to can help lower blood sugar levels by using up the excess glucose in the blood stream. Every person responds differently though, so if you do have Gestational Diabetes, please work with your care provider in finding the management plan right for you.

Some women develop a high level of insulin resistance, despite eating balanced and spaced out meals and snacks, and exercising regularly. These women continue to have consistently elevated blood glucose levels. I was one of those women.

When my hormones peaked at 32 weeks, I would not be able to eat a chicken and salad sandwich of barely 30g of carbohydrates without my blood sugar spiking well above the ‘allowed’ limits. People kept telling me to “control” my diabetes. I thought I was doing something wrong because my blood sugar levels were so high, so I reduced my carbohydrate intake drastically. The dietician put me on insulin when I started losing weight (and I was only 140lbs at 32 weeks, so didn’t have much to lose!), I had no energy and I was and spilling ketones into my urine.

If, like me, you are doing all you can and you still need insulin, please be kind of yourself – it’s not your fault. Remember, you can’t control this. You have a medical condition. You are insulin resistant. Your body just needs some help. Injecting insulin is very easy (I found it virtually painless, and nowhere near as unpleasant as the finger-prick tests!). It helps your body by giving it the extra insulin it needs when your pancreas is producing as much insulin as possible but your body is still unable to lower your blood sugar level.

Despite the myths floating around, a diagnosis of Gestational Diabetes does NOT mean you will automatically have a big baby. It does NOT mean you automatically need to have a cesarean. It does NOT mean you cannot VBAC. It does not mean your baby will definitely need to go to the Special Care Nursery… You have options, and a gentle, calm and intervention-free vaginal birth with gestational diabetes is possible for most women.

diabetes insulin pen

References:

Australian Diabetes Council. (2013). What is Gestational Diabetes. Retrieved on February 28, 2013, from http://www.australiandiabetescouncil.com/About-Diabetes/Gestational-diabetes

Buckley, S. J. (2008). ‘Gestational Diabetes Testing’. In Gentle Birth, Gentle Mothering: A Doctor’s Guide to Natural Childbirth and Gentle Early Parenting Choices. Retrieved on March 31, 2013, from http://www.fullcirclemidwifery.com/2009/02/gestational-diabetes-information/

Goer, H. (1996). Gestational Diabetes: The Emperor Has No Clothes. The Birth Gazette, 12(2). Retrieved on April 1, 2013, from http://www.gentlebirth.org/archives/gdhgoer.html

National Diabetes Service Scheme. (2013). Gestational Diabetes. Retrieved on February 20, 2013, from http://www.ndss.com.au/en/Diabetes-Information-Sheets/Gestational-diabetes/

National Diabetes Information Clearinghouse. (2013). What I need to know about Gestational Diabetes. Retrieved on March 1, 2013, from http://diabetes.niddk.nih.gov/dm/pubs/gestational/

National Institute for Health and Clinical Excellence [NICE]. (2008). Diabetes in pregnancy: Management of diabetes and its complications from pre-conception to the postnatal period. Clinical Guideline 63. Retrieved on April 1, 2013, from http://www.nice.org.uk/nicemedia/pdf/CG063Guidance.pdf

Odent, M. (2004). Gestational Diabetes: A Diagnosis Still Looking For a Disease? Primal Health Research: A New Era in Health Research, 12(1). Retrieved on April 1, 2013, from http://www.bellybeginnings.com/Handouts/GestationalDiabetes-Odent.pdf

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