Birth Planning

There is a number of things that should be considered when you are creating your birth plan, and I need to be honest with you. This is the part that you will not be super happy about! NO ONE IS GOING TO READ YOUR THESIS ON YOUR BIRTH. There, I said it. This is what I have seen when it comes to those two and three-page birth plans. First things first, you have spent hours researching and planning exactly how you want your birth to be, and you put it into a three-page document that you will bring to your birth. Here is what will happen, and I speak from experience. You will hand this to your birth team, and they will glance over it, put it on their desk, which is right next to where they are charting, and will not look at it again, and will bombard you with questions throughout the entirety of your birth.

I create a visual birth plan for my clients. Here’s why I wanted it to have their preferences in the form of icons or pictures. I wanted a document that can be hung on the whiteboard so that when there is a shift change or a provider change, it is right there accessible, and everyone can see it, the best part is that no one has to ask you the same questions 100.000 times. That way you can focus on laboring, and not on answering the same questions over and over again.

As a doula, we are going to complete this during our first prenatal meeting. This is for a couple of reasons. First, it helps me to understand what you know, and what you don’t. What things you need more information on, it also gives me an idea if a childbirth education class would be helpful. In all honesty, I don’t care if you take mine, but please take one. Even if this is not your first pregnancy. We have seen so many changes over the years, and protocols change. Taking a childbirth education class is one way that you will know what to expect, and how to make the best choices for you and your family.

Here are a few things that you should consider: (not a complete list)

• Are you keeping your placenta (it’s yours, you can)

• Plans for eye ointment.

• Circumcision

• Epidural

• Medication or no medication

• No bath for baby

• Nitrous

• Birth Environment

• Music/no music

• Type of birth (hyno-birth)

• VBAC

These are just a sample of some of the topics to consider. Here is another thing that I want you to think about. Please include a postpartum plan. Spend as much time planning for the birth of your baby , planning for post-partum. Have conversations about what type of support will be helpful to your family. Would a post-partum doula be helpful? Do you know an IBCLC(International Board Certified Lactation Consultant) HOw many people will you allow to visit your baby in their first few weeks of life? Have you done any meal prep? Trust me when I say, tensions can run high when you first bring you baby home. There is feeding, diapers, and sometimes not a lot of sleep. Having theses conversations before you have the baby is critical.

I’m here if you need any support, and you are going to do great things!!

XOXO-Holly

Easy/Healthy Meals for Pregnancy

One of the most common issues that I hear is that there seems to be some confusion about what to eat or not eat during pregnancy. What can contribute to this issue is that a lot of providers have a hard with nutrition in general, as there is not a lot of time spent specifically on nutrition in medical school, so the most common advice is to eat healthy. What does that mean. The first thing that I want to say is during pregnancy, there is always risk. We have to be able to discern the amount of risk that we want to take. While there are food allergies to consider, the actual risk of things like contracting listeria from soft cheese is very small. Now let’s talk about time. We are busy, and while I have a great appreciation for food, most of us don’t have extra hours in the day to spend meticoulsy preparing every meal. Below are some of my go to easy recipes that pack a nutritional punch.

Breath and Birth MN Bone Broth:

Breath and Birth Bone Broth

Ingredients:

Chicken or Beef Bones

2 cloves Garlic

3 carrots

1 Onion

2 Stalks Celery

6-8 Cups of water

1 TBSP Olive Oil

Directions:

This can be prepared in an instant pot, or in a stock pot on the stove. Smash the garlic. Cut the Celery and Carrots into thirds. Slice the onion, and add the water and Olive Oil. If you are using an instant pot, set the times for about 4 hours, and if you cook on the stovetop, I usually boil on medium for about 6 hours. BE CAREFUL WHEN THIS IS DONE. I let it cool slightly and strain it into mason jars. When you prepare the homemade bone broth, I like to use it up in 4-5 days.

Breath and Birth Vanilla Chia Seed Pudding

Ingredients:

Vanilla Chia Pudding:

4 TBSP Chia Seeds

1 cup Oat Milk

1-2 TBSP Maple Syrup

1 tsp Vanilla

Directions:

Combine all of the ingredients and let sit for 10 minutes. It couldn’t be any easier. I like to put this in the fridge overnight and add fresh berries or serve on some steel- cut oats. I keep this on hand in the fridge in a mason jar. Chia seeds pack a nutritional punch and this is a great snack option.

Ingredients:

1/2 Cup Frozen Blueberries

1 1/2 cup Oak Milk, or Almond Milk

1 TBSP Almond Butter

1/2 tsp Vanilla

Blend the above ingredients in a blender until creamy. Pour into a bowl and top with fresh blueberries, slivered almonds, chia seeds, and granola. Enjoy!

There are so many ways to prepare something quickly and easily. The best way to take care of the body is by giving it nutrient-dense foods. We don't need to make things complicated. The above recipes are more nutrient-dense and easy to make.

XOXO-Holly

Essential Oils in Labor and Delivery

I often am asked what I carry in my birth bag. If I'm being honest, not much. I carry bathtub handles for the birth tub so we can do Gilligan's Guide, some amino acids for myself, my camera if you have commissioned me to photograph your birth, your visual birth plan, some N95 masks, a traditional rebozo, and a few essential oils. Everything that you or I, as your doula, needs is available at the hospital or birth center and certainly at a home birth. Now, listen, I need to be honest with you. We will get a diffuser out for essential oils if that is important to you, but the oils I bring we also use on the body to release tight muscles and fascia and help you get into your birth space. I am not going to sell you on joining an MLM, that's not my jam, but I will share the oils that I use in the birth space and some helpful ones to have on hand at home and ones that will also work on the kiddos.

The two brands that I love are Plant Therapy and Young Living. Let's talk about the ones that I love for the kiddos.

Great on-the-go hand sanitizer.

Great for Growing Pains!

Use for Face Before Bed!

Neck Massage before bed! Great Calming Oil.

I’m going, to be honest, when I met my doula bestie, she smelled amazing! Honestly, I asked her name, and then immediately asked what scent she was wearing. It was a Young Living oil. As we got to be better friends, I began to learn a lot more about oils and ditched all the products that I had been using due to the number of toxins that were in most of the products that I had been using. I ordered from her often, until I finally signed up for Young Living as I wanted to be eligible to earn free products and get a discount. In full transparency, I have no desire to have a team, sign people up, or run an essential oil business. Period. I do however feel like I should share some of my coveted products, because they smell amazing, and are good for the body! Here’s the other thing, even my husband kinda rolled his eyes when my first order came, until his neck was killing him, and I pulled out the Deep Relief. Now, it is a full-on panic if there isn’t any in the house.

The One That Every House Should Have!

Helps with anything from sore muscles, nausea, and headache.

Lime, Cedarwood, and Lavender.

I can never shut my mind off at bedtime, and this helps me a ton!

I’m not going to try to convince you that you have to have these, but they were game changers for some of my clients, and for myself. I NEVER go to birth without them! EVER! I have a lot of oils from both companies and I have never been disappointed. I have replaced all the fragrances in our home with essential oils, and have never looked back. When I started to pay attention to how toxic beauty and body products are, I had to make a change. Here is what you need to know. The associative nature of the emotions that are attached by people to scent means that those smells that we tend to link to stressful/unpleasant healthcare situations, such as the eugenol (i.e., clove) smell of a visit to the dentist’s surgery, can all too easily end-up making us stressed (Robin et al., 1998, 1999). Over the years, researchers have also investigated the use of fragrance to help reduce stress during other anxiety-inducing medical procedures (e.g., Graham et al., 2003; Braden et al., 2009; Redd et al., 2009; Kritsidima et al., 2010; Ghiasi et al., 2019). There is also a growing body of research to suggest that ‘sweet-smelling’ ambient scents can help people deal a little better with pain (e.g., Prescott and Wilkie, 2007; though see also Marchand and Arsenault, 2002; Martin, 2006).

Based on the research above, we know that scent matters. That being said, the above brands and products have made a huge difference in this house, and I have also seen how scent can impact the birth space. Do yourself a favor, and treat yourself to some of these products. You’ll be happy you did!

If you would like to order from Young Living, here is my link.

Spence C. Using Ambient Scent to Enhance Well-Being in the Multisensory Built Environment. Front Psychol. 2020 Nov 19;11:598859. doi: 10.3389/fpsyg.2020.598859. PMID: 33329267; PMCID: PMC7710513.

XOXO-Holly

Most Common Nutrient Deficicies During Pregnancy

I hear a lot of the same thing regarding nutrition and pregnancy. You are all asking your providers about food, and really what people are being told is that they should eat healthily. What does that mean? That's where I can help. Knowing what will grow a healthy baby, what foods are nutrient-dense, and how to prepare meals and meal plans is one of the best and most important things you can do. I have found that most people don't know where to start, and worse, people are often told that as long they take their pre-natal vitamins, they should "be fine." What is important to note is that "essential vitamins and minerals are dietary components required in small quantities to support virtually all metabolic activity, including cell signaling, motility, proliferation, differentiation and apoptosis that regulate tissue growth, function, and homeostasis." Vitamins and minerals support every maternal, placental, and fetal interaction stage to enable a healthy gestation.

 One of the most common deficiencies is iron, and there were even some studies that I came across that said that almost 40% of pregnant people had a prevalence of low serum iron concentration. Let's talk about foods that are nutrient-dense in iron. "The recommended intake of iron is 27 mg per day in pregnancy vs. 18 mg per day in non-pregnant women." Iron plays a vital role in red blood cell production and is essential as it supports your growing baby and placenta. Iron deficiency can increase your risk of premature birth and contribute to low birth weight. Iron supplements aren't always the best way to ensure that you are meeting your needs as the side effects are often undesirable, and of the people that did take the supplements, 89% stopped taking them due to the side effects. So, your best bet is to get as much as possible through your diet. The best source of iron that you can get is the liver. I know not many people are excited about that choice, but if your iron is low, it is probably your best bet. What are other foods high in iron? Red meat, game meat, oysters, sardines, dark meat, and poultry, If you are vegetarian or can't stomach some of the above choices, spirulina (a type of algae) is another option.

Another group of vitamins that we tend to see a high deficiency in is B6 and B12. Vitamin B6 is critical for your baby's developing brain and nervous system and helps the baby metabolize protein and carbohydrates. B6 is also helpful in managing your nausea or morning sickness. In a study out of the University of Michigan, some found relief by taking 10-25 mg of Vitamin B6 3x per day. (check with your provider to see if this is a good option for you). Sources of Vitamin B6 are Beef liver, tuna, salmon (fresh caught), fortified cereals, chickpeas, poultry, dark leafy greens, bananas, papayas, oranges, and cantaloupe. Vitamin B12 is vital for maintaining the health of your nervous system and is also essential for your baby's developing brain and spinal cord, forming healthy red blood cells, helping make D.N.A. and can help to prevent the risk of neural tube defects. In large part, B12 is found in large amounts in animal products, fortified foods, dairy products, eggs, and poultry.

Iodine. This one does not always get the attention that it deserves. According to one study, "iodine deficiency during pregnancy can cause maternal and fetal hypothyroidism and impair neurological development of the fetus. Iodine requirements are increased by 50% during pregnancy. In some cases, supplementation before or during early pregnancy eliminates cases of cretinism, increases birthweight, reduces perinatal and infant mortality rates, and even increases developmental scores in young children by 10-20%." (PubMed) Iodine is mainly found in animal-protein foods and sea vegetables. While some items like cereals, bread, and milk are fortified, there are more nutrient-dense choices. Seaweed, fish, shellfish, table salts labeled "iodized," eggs, beef liver, prunes, lima beans, and chicken are all sources of iodine.

A lot more goes into a nutrient-dense diet than eating healthy. That is just not sound advice. The other topic I want to address is that most people don't understand. How much do I need? What foods are nutrient-dense? What foods need to be paired together so that we can maximize absorption? These are all the questions we go through, personalized to your specific needs and wants, in my Pre/Postpartum Nutrition meetings. For a short time, I am offering a 60-minute session for $39 as I complete my clinical hours to sit for my exam with the NANP. If you are interested in scheduling one of these, here is the link. We will discuss how to create a nutrient-dense diet to help develop a healthy baby and postpartum time. You will have all the resources and tools you need. No more guessing! I'd love to work together.

I

Be well,

XOXO-Holly

Gernand AD, Schulze KJ, Stewart CP, West KP Jr, Christian P. Micronutrient deficiencies in pregnancy worldwide: health effects and prevention. Nat Rev Endocrinol. 2016 May;12(5):274-89. doi: 10.1038/nrendo.2016.37. Epub 2016 Apr 1. PMID: 27032981; PMCID: PMC4927329.

https://doi.org/10.1093/jn/135.5.1106

Nichols, L. (2018). Real Food for Pregnancy: The Science and Wisdom of Optimal Prenatal Nutrition. Lily Nichols.

Setting Post-Partum Expectations

We need to prepare for post-partum as much as we prepare for birth. We need our support system to show up. We need to be having hard conversations with each other, and friends and family. We need to be planning for what we are going to need, and I am here to tell you, it is a lot more than just picking out the crib and stroller. I always tell my clients…..I will always tell you the truth, and here is the truth. Where do I see a great opportunity? Not just in bringing home your first baby, but baby number two. There is more to think of, and more to be ready for. Let’s talk about how we can be ready, and I’m gonna keep it real. I don’t want people to go into the romanticized idea of coming home. I want you to be prepared for the reality of coming home, and it can be hard. Have conversations about sleep, meals, and how your people can help you. How can you alternate making sure that you each are getting some sleep? Nothing causes more issues with your ability to regulate the nervous system and heal than lack of sleep, not to mention the ability to think clearly. Sleep is so important!

There is a lot to think about, but if we are prepared, we will be able to enjoy this time and feel supported. You need to be able to heal, love on your baby, and sometimes assimilate another child to this new world, and planning will make it better. One of the first things that I recommend is having a conversation with your partner about what the roles in the house are going to look like. The laundry, meal prep, errands, and everything else it takes to make your household run smoothly isn’t going to stop, so having conversations about these things will save endless tears, I promise.

Meal prep is a game changer, and not just when you first get home. If you are going to breastfeed and heal from birth, nutrition is a critical piece of this puzzle. You are not going to feel like preparing meals, but you are going to need meals so anything you can do to prepare for this is going to help. I always recommend people to have an instant pot. Now, don’t roll your eyes. That’s exactly what I did when my mother told me that I needed one. I ignored her advice on this for months, that is until she showed up at my house with a roast and her instant pot. This seven-pound roast with vegetables was ready in 50 minutes! You read that right, 50 minutes! A healthy meal that is packed full of nutrients only took that long. Steel-cut oats take two minutes to make, add some fruit, and nuts and you are able to start the day with the nutrition that you need to heal and take care of your baby. It is a game changer, and if you don’t have one, consider getting one. I have some sessions available at a discounted price for a 90-minute meal and nutrition consultation. We will cover how to meal prep, recipe planning, and how to make the most nutrient-dense breastmilk you can. Schedule that here.

One of the best things that you can do is have conversations with friends and or family about how they can help. People can’t come over if they aren’t going to help. Period. Don’t entertain your people. In order to visit, they need to prepare food, fold some laundry, and most importantly, listen. My favorite kind of visit is when they stop by, leave goodies at the door, and text a sweet message. Don’t be afraid to let people know how to support you, or what you need. These are your people. They love and adore you. You should be able to count on them. Gone are the days when the birthing person entertains the people who come to visit. It’s not helpful to anyone, and you don’t need any more work. My experience has taught me that people really do want to help, and if you let them know what you need, they will deliver.

Your goals upon returning home with your sweet, sweet baby need to be focused on you and your humans in your home. Be intentional in your conversations. Discuss meals, sleep, a break ( maybe you need to run to target because you want to, not becuase you have to), what can they do so that you can spend time with your baby and heal. This is a really precious time, and I want you to look back and realize that you came through the other side with amazing memories, a full heart and a lot of support. Support that you thought through, made known, and that your people delivered. There will be hard days, but there will also be days when you amaze yourself at your strength, at your ability, and you will look to the future and know that you can do it. I know that sometimes it seems impossible to imagine, but take it from me. My oldest is headed to college, and he was a NICU baby. It was hard. Despite all of that, I still look at him with amazement and think back to the endless days and nights in that NICU where everything was uncertain and I had no idea what to expect, and my people showed up in more ways than one. As he towers over me about to start the next phase of his life, I see that tiny baby sometimes, and you know what I think? I did it. I made it through all of that, but I didn’t just make it through, I loved a lot of it. I find myself still needing my people to show up, because I now know that raising these tiny humans is the greatest acheivment of my lifetime, and I look forward to watching, cheering, and supporting their next steps because I know what is possible.

XOXO-Holly

What Role Does Fear Play in Birth?

Fear. Depending on whom you speak with, fear has many different roles in birth. There are even people talking about removing fear from your birth, and I want to talk about it. There are several different elements to this type of thinking. One that should be noted is that if this is your first baby, almost everything regarding this experience is new to you. Frankly, I think that it is human nature to feel fear. You are walking into a new experience, the unknown and unfamiliar to YOU. I want you to read that last sentence again. This is new. It is natural to have fear surrounding this experience and what it will involve. Now, overwhelming, debilitating fear, looks different, and we will talk about this aspect shortly.

Let’s talk about what happens biologically during the birth process. “In response to fear, our bodies release adrenaline and cortisol, and these hormones play a fundamental role in the physiology of birth. Endorphins released in response to pain also contribute to the altered state of consciousness associated with physiological labor. Often there is an altered state of consciousness associated with labor. When the limbic system dominates the neocortex, expected behaviors and cultural norms are disregarded.” (Reed) What does this mean? We don’t control fear in the ways that some people think. It is impossible to let go of all fear. Due to the unpredictability of birth, whatever approach you take, there will be some fear. How can we then lessen the amount of fear in the birth space? I think there are a few different approaches that can help with the process. I think that telling people to remove all fears that are associated with birth is not fair, and certainly not helpful.

We have to take a look at what types of fear exist. One word comes to mind. Change. Things are going to change. Your family dynamic is going to change. There will be one more little person that needs care and is dependent on you. How can you lessen the fear associated with this? Planning, preparing, and education is a great place to start. Flexibility can play a very dominant role in the future. Trust me, I know how hard this can be. I thought with my first child that I would be able to control everything. Scheduled feedings, bedtimes, and diaper changes were the first things that I put in place. The schedule was more about control than it was watching my baby for feeding cues. It didn’t work, and we had to adapt quickly. I am not going to tell you what processes to put in place for your family, however, I will provide tools and resources so that you feel prepared. One important thing to remember is that what works for one family may not work for another. The trick is to find what works for YOUR family.

There is a common theme that dictates fear. Pain. The medical industrial complex will have you believe that pain should be removed. It’s simple, get an epidural. They will liken this to getting a tooth pulled, On the other hand, natural birth advocates think that pain should be part of the experience. They think that we have been conditioned to think that birth is painful, and if we do certain things, we can eliminate it completely. Here’s the thing. I will always tell you the truth. ALWAYS. I think in order to get to the bottom of these theories, we need to discuss pain in simple terms. A person’s perception of pain always comes into play. Everyone’s experience will look different.

Fear serves a purpose. In looking at the human experience, it is what signals our fight or flight. It can be what keeps us safe. There is something called the neo-matrix theory of pain. “This theory purports that pain is produced in response to an actual or perceived threat by a matrix of neural structures in the brain. Inputs into the central processing areas of the brain are multidimensional and include nonbiological contributions to the experience of pain. Therefore, a number of factors influence labor pain perception, including beliefs, expectations and past experiences, emotional state, acceptance of the experience and social context.” (Whitburn) It is also important to note that “research has also found that acceptance of pain during birth enhances the woman’s capacity to cope with it, and that having a pain-free birth does not improve women’s overall experience.” (Whitburn)

The uncertainty and unpredictability are what contribute to fear by a culture that aims to control everything and eliminate all unpredictability. (Reed) I think that we can control what we can, and be prepared for the things that we can’t. There can be surprises, and things that are just frankly out of anyone’s control, but there are things that can help with the process. Get a doula. It will be the best money that you spend. Someone that supports you and your partner and that will provide unbiased support. Someone that does not push their agenda of what they think your birth should look like. Take a childbirth education class. I have found that if we know what to expect, we are able to process the experience a little easier. Learn about physiological birth. Last but not least, everyone wants to share their birth experience with pregnant people. Kindly ask them to hold their story until after you have your baby. There is no reason to bring all of their experience into yours.

There are ways to manage pain in labor and delivery. How we move our bodies, how we use our breath, and the support we fill our birth space with all has an impact on the fear and pain that we can experience in labor. Be mindful of who you have supporting you, and educate yourself on physiological birth and the biomechanics of the pelvis. The more we know and can level set our experience, the better you feel going into this journey.

XOXO-Holly

Reed, R. (2021). Reclaiming Childbirth as a Rite of Passage: Weaving ancient wisdom with modern knowledge. Word Witch.

LY Whitburn, LE Jones, M-A Davey, and S McDonald, ‘The nature of labor pain: an updated review of the literature”, Women in Birth, 2019, 32 (1):28-38, doi10.1016/j wombi.2018.03004.

Breastmilk Nutrition... Part 2

There’s a lot to understand when breastfeeding, and when we know what we need, things seem a little easier. I want to let you know, that however you feed your baby, that is the right decision for your family. I was always getting so many questions about what to eat or not eat, and my hope is that this will explain a few things and help you understand the transfer of nutrients to breastmilk.

Choline is needed for brain development, the integrity of cell membranes, lung surfactant, and bile acids just to name a few. Choline concentrations double in human milk six to seven days postpartum. It then increases again from days 7-22, reaching a steady level in mature milk. The choline requirements in lactation are 550 mg vs. 450 mg in pregnancy. There is some research that suggests higher intakes may be optimal. A dose of 930 mg a day significantly increases choline and glycine in milk. The research suggests that higher choline levels in milk do correlate with better infant recognition memory, and choline inadequacy in young children correlates with stunting. Choline-rich foods are eggs and liver, however, you may find lesser amounts in meat, fish, dairy, nuts, seeds, legumes, and cruciferous vegetables. If you don’t consume eggs, supplementation is a good idea.

Vitamin C is an antioxidant that supports immune health. Leukocytes and antibody production all benefit from Vitamin C. The highest amount of Vitamin C is in colostrum and decreases in mature milk. There is a wide variety in breastmilk concentrations, which is related to maternal status and dietary intake.

Fatty Acids. The type of fat in the diet directly impacts fatty acids in the milk. This is true for Omega 3 fats, Omega 6 fats, transfats, saturated fats, and non-saturated fats. Another important point to note is that milk fatty acids can be drawn from maternal stores or synthesized in the breast. There have been over 150 different fatty acids identified in human milk. The quality of animal fat does seem to matter. There was a study done in the Netherlands that determined that people who ate an organic diet of meat and dairy from organic sources had a much higher level of CLA (conjugated linoleic acid) in their milk. CLA has been shown to benefit metabolism and immune function and could lower the risk of allergies and asthma in infants. Now let’s talk about the type of fat. Healthy fat is unprocessed fat. Examples of these are olive oil, avocado oil, macadamia nut oil, and coconut oil, animal fats (from healthy animals), dairy fat like butter, ghee, and cream just to name a few. If possible, avoid excessive intake of Omega-6 fats (vegetable oils), trans-fats, and partially hydrogenated oils. Studies show that there is no safe level. Unfortunately, the US has the highest level of trans fat due to our highly processed diet.

DHA. Studies have shown that people with a high level of DHA in their breast milk have better neural and visual development. The concentration of DHA in human milk varies more than 10-fold and depends on the mother’s dietary intake. A lot of the variation can be explained by the dietary intake in late pregnancy (3rd trimester). Food sources high in SHA are as follows: seafood, fish, eggs, and grass-fed beef, Research does show that breast milk concentrations of DHA do reach a “saturation level” at maternal intake of 500-100 mg per day. If seafood and fish intake are low or inconstant, it can be helpful to take a supplement (fish oil, krill oil, or an algae-based DHA. Vegetarian or vegan diets must use an algae-based DHA supplement to supply adequate DHA.

Vitamin A is critical to infant growth, immune system, brain, and vision development. Colostrum is higher in vitamin A than mature milk and this is necessary to build infant liver stores. In the first six months of life, babies receive 60x ( yes sixty), a higher amount of vitamin A than they received during the 40 weeks of pregnancy. The amount found in breast milk depends on maternal intake. One thing to note is that Vitamin A levels decline in milk over time. There have been numerous studies that show breast milk is often low in Vitamin A 46% of the time. Here is one thing that I will caution you about, if you are going to supplement Vitamin A, the type of Vitamin A matters, and it is a good idea to partner with your provider in regards to the amount. Vitamin A is one of the vitamins that can build up to toxicity, so don’t run out and consume a lot of it without partnering with a dietician or provider. There are plenty of food sources for Vitamin A such as butter, ghee, lard, tallow, and some seafood.

Breast milk is commonly regarded as low in Vitamin D. The concentrations are dependent on maternal intake and production from sunlight. Approximately 20% of maternal vitamin D is transferred into the milk. There are also higher levels in hindmilk rather than foremilk. Studies show that supplementation of 6400 IU per day supplies adequate amounts to maintain maternal serum levels. Studies have also shown that there is no need to separate infant supplements if mothers are supplementing. Studies show that food is not the greatest source of Vitamin D, so head outside and get some sunlight.

I realize that these last two blog posts are pretty full of info. One thing that I want to remind everyone of is that your diet does not need to be perfect. Your breast milk is still FULL of what your baby needs. I often get asked how people should know what is important, and what is actually going into your breast milk. I am hopeful that this information has broken down the nutrient density of breast milk and left you with information on how you can make the biggest impact.

Breastfeeding can be a little overwhelming, and when you are also trying to consume a healthy diet while doing everything else as a new parent, it can seem like it is hard to know where to start. A healthy eating plan is imperative. I can simplify this process for you. Schedule a time with me here.

XOXO-HOlly

Nichols, L. (n.d.). Nutrition for Breastfeeding – Womens Health Nutrition Academy. Lilynichols.Com. Retrieved June 21, 2022, from https://whnacademy.com/product/nutrition-for-breastfeeding/

Breastmilk Nutrition.......Part One

I recently took a class taught by Lily Nichols on this topic, and the information is just too important to not share. First, I want to say a couple of things. Breastfeeding is not possible or a choice that everyone makes, and that is ok. I have had a difficult breastfeeding journey with each of my three boys and with my middle son, I wasn’t able to breastfeed at all. That being said, I do remember being very confused about what could, should, and shouldn’t consume, and I really had no idea how any of it impacted my milk. The other thing that I share before I break some of this information down is that this is a topic that is not readily available. Honestly, it wasn’t covered in any of the lactation training s that I have taken, and it’s pretty important stuff. I would like to add that if formula feeding is your choice, or if you choose to not chest feed your baby, I support however you choose to feed your baby.

The nutrient transfer in breast milk is widely variable. It is very dependent on maternal intake. The following vitamins are very dependent on maternal intake. B1, B2, B3, B6, B12, Vitamins A, D, E, K, choline, and fatty acids (DHA). The following are less dependent on maternal intake: folate, iron, calcium, and most trace minerals. The maternal body will pull from stores for folate. Supplementation can also be helpful, but there are a lot of factors to consider when supplementing and choosing a supplement.

Let’s start out by discussing why any of this matters. At birth, a baby’s brain is only 25% developed, and it will doubles in size in the first year of life. Then there are the first 1000 days which are conception until age two. This time period is critical to brain development and epigenetics for a child. What needs to be a primary thought is what are we setting our children up for. One thing that can’t be disputed is the nutritional transfer via breast milk. That being said, we can’t transfer what we do'’t have. There is a lifelong benefit to this. “Key nutrients that support neurodevelopment include protein, zinc, iron, choline, folate, iodine, vitamins A, D B6, B12, and long-chained polyunsaturated fatty acids. Failure to provide these key nutrients during this critical time of brain development may result in lifelong deficits in brain function despite subsequent nutrient repletion.” (2018 American Academy of Pediatrics) What does this mean? We get one shot at this.

This also means that it is wise to look at the maternal diet. Here is one thing to note and I’m gonna bold in this next part! EVEN IF A MOTHER’S DIET ISN’T PERFECT, HER MILK IS STILL A SUPERFOOD! That being said, milk with a lower level of nutrients is a risk for both mom and baby. If a birthing person goes into their pregnancy nutrient deficient, what we know is that they are entering postpartum and their lactation journey nutrient deficient. One thing that should be noted is, at times it can be difficult to measure the exact nutrients of breast milk as there are a few things to consider. What stage of nursing are they at? Colostrum vs mature milk. What time of day is it being measured? How is the milk being handled? What are the different assays of the lab that is working with the milk? (milk banks) Let’s talk about some of the other nutrients and what the contents are.

Protein. Amino acids are highest in colostrum, and we see a decline in mature milk. This process does stabilize after about four months postpartum. There is a definite shift in amino acid concentrations at different stages of infant development. Protein concentrations can shift with variable intake, and we do see a lower protein content after an overnight fast. This also brings up another interesting point. I get a lot of questions regarding intermittent fasting and breastfeeding. The overarching consensus is that it is not a great idea during lactation.

FAT. This topic is one of my favorites and is a really important element of breastmilk. There is also a highly variable content depending on maternal intake. The percent of fat in breastmilk varies up to 50%. There are also three sources of fat which are diet, the synthesis of nutrients in the breast, and maternal fat stores. Fat content is highest in colostrum, lower in mature milk, and highest in hindmilk. There are a couple of things to note, leaner women will make lower-fat milk. This matters as these individuals will need to look at having a higher fat content in their diet. Your babies NEED fat! There is also no direct link between the number of times you nurse, and the fat content in milk. You won’t make more milk because you have more fat in your diet. The fat content of the milk will change, not the amount of milk produced. As long as we are speaking about fat content, that brings us to another interesting point. Breast milk of nutrient-depleted mothers only produces a portion of some of the necessary micronutrients. For example, breast milk only contains 60% of thiamine, 53% of riboflavin, and 16% B12.

B12. This is an incredibly important vitamin to be aware of. The amount found in breast milk is highly dependent on maternal intake. Your B12 status during pregnancy is an indicator of your b12 status in lactation. Here are some of the things that we see in infants who are deficient in B12. Irritability, poor feeding, severe growth stunting, marked developmental regression, (especially in motor skills)demyelination, and excessive sleepiness. Symptoms of this type appear around four-seven months of age. The is one really CRITICAL item to note with this. Deficits are NOT reversed by treatment about 40%-50% of the time. There are a few risk factors with this. Vegetarian and vegan diets (when not adequately supplemented), if someone has poor absorption of certain types of anemia. There are a few things that can really help. KEEP TAKING YOUR PRENATAL VITAMIN. B12 needs are higher in lactation with the RDA of 2.8mcg vs 2.6 mcg during pregnancy. There is some research that indicates that levels that are 3x higher than the RDA are necessary to maintain adequate levels of B12 in breast milk. How can you ensure that you are getting enough? Here are some foods that are high in B12. Clams, oysters, liver and organ meats, red meat, and there is some but in much lesser amounts in eggs/dairy. It is highly recommended that vegans and vegetarian diets supplement lactation above the RDA to ensure that there are high enough levels in their breast milk.

This is a lot of information, but at the end of the day, we need to realize that our nutrition matters. We can’t give what we don’t have, and it is really difficult to heal without making sure that we are getting enough nutrtion for ourselves and our baby. There is much more info on where this came from, and I will write another post continuing all of this next week. Up next….Choline, Vitamin C, Fatty Acids, and DHA.

Breastfeeding can be a little overwhelming, and when you are also trying to consume a healthy diet while doing everything else as a new parent, it can seem like it is hard to know where to start. A healthy eating plan is imperative. I can simplify this process for you. Schedule a time with me here.

XOXO-Holly

Nichols, L. (n.d.). Nutrition for Breastfeeding – Womens Health Nutrition Academy. Lilynichols.Com. Retrieved June 21, 2022, from https://whnacademy.com/product/nutrition-for-breastfeeding/

The Age of Influencers...........and Preeclampsia

We need to talk. I love me some Instagram, but I need to share something that has been on my heart for a while. Choose who you follow, and who you allow you to impact your decisions carefully. Here’s why, lately I am seeing downright dangerous advice. Now, I know that most people are careful, and I also know that people want what is absolutely best for their baby, that being said, just DO YOUR OWN RESEARCH. Just yesterday I saw a post that was downright false and dangerous. I’ll share it with you. An account run by someone who offers childbirth education, AND is launching a doula training program made several posts about how Pre eclamsia can be managed with exercise and diet. THIS IS FALSE. She even went so far as to say that it isn’t really a medical emergency if someone is presenting with some of the tell-tale signs that very obviously are emergent in a lot of cases.

Preeclampsia is a complication that is characterized by high blood pressure and signs of damage to another organ system, often the liver or the kidneys. It usually presents after 20 weeks in people who have had normal blood pressure. Here are the facts. This can lead to a serious-even fatal-complications for both the birthing person and the baby. Below are some of the signs of preeclampsia:

• Excess protein in your urine

• Severe headaches

• Changes in vision, including temporary loss of vision, blurred vision or light sensitivity

• Upper abdominal pain, usually under your ribs on the right side

• Nausea or vomiting

• Decreased urine output

• Decreased levels of platelets in your blood (thrombocytopenia)

• Impaired liver function

• Shortness of breath, caused by fluid in your lungs

I’m sorry, but the above-mentioned symptoms should not be ignored, nor should they be rectified with diet and or exercise. This is absurd!! The specific cause of preeclampsia includes several different factors, and experts believe “it begins in the placenta-the organ that nourishes the fetus throughout pregnancy. Early in pregnancy, new blood vessels develop and evolve to efficiently send blood to the placenta. In women with preeclampsia, these blood vessels don’t seem to develop or function properly. They’re narrower than normal blood vessels and react differently to hormonal signaling, which limits the amount of blood that flows through them.: (Mayo Clinic)

That brings me to my next point….Do some of your own research. I will go back to what a doula’s role is. We should not be giving medical advice, we should not be inserting our views of what you should do. I’m going to be honest on this one, RUN if that is the practice of a doula you are considering. As I see what some of these accounts on Instagram are sharing, I cringe, and I also worry. Before you follow blindly, consider their training. Look at their profile. Do they have a website that very clearly list’s their credentials, or are they someone that just has a lot of opinions which then would make them full of bias and render them unable to provide sound evidence-based information. I just had to get this out there. There are a ton of reliable accounts giving great information, and there a lot of accounts giving uninformed opinions of topics that could lead you down a path of making dangerous decisions. I urge you to consider these points when making decisions for your family. Ask the questions, and read the evidence. You have a right to make decisions that you feel comfortable with, AND that make you feel safe. Someone’s dangerous bias has no place in your birth space.

XOXO

https://www.mayoclinic.org/diseases-conditions/preeclampsia/symptoms-causes/syc-20355745

Induction

I’ve heard all the reasons why providers want to do an induction. Some are necessary and some are just for convenience, Let’s go through a couple of them. I have heard providers tell people that their baby is going to be big, that their provider is going to be on vacation, and in some cases, people elect for induction because they are tired of being pregnant. That being said, there are some very real reasons for induction. A few of those are preeclampsia, fetal growth restriction, RH incompatibility, 42 weeks past guess date, Oligohydramnios (not enough amniotic fluid). There are many reasons why an induction could be necessary, but what I want you to understand more than that is the process, and that it can take days. Yes, days. I have actually heard providers tell their patients that they will meet their baby much sooner with an induction, and I am here to tell you that in most cases, that is not true. It’s a process.

Let’s talk more about the process, and what to expect. First, you need to understand that induction and actual labor are two separate events. They are not one and the same. The first step is to ripen (soften) the cervix. This is done by using Cervidil or Cytotec. This process can be taken orally or vaginally. The usual dose is 50mcg orally or 25mcg vaginally, and can be repeated every 4 hours if contractions are absent or not painful. In other instances, a small tube (catheter) with an inflatable balloon on the end is inserted into the cervix. Filling the balloon with saline and resting it against the inside of the cervix helps ripen the cervix. Once your cervix is sufficiently relaxed or dilated, your provider will begin the second step. This usually involves stimulating the body to produce contractions if they have not started on their own. A medication called Pitocin is used to stimulate contractions. This is usually administered through an IV drip, and they begin with a small dose, and this can be gradually increased until contractions are strong and frequent. Unless your pregnancy has been diagnosed as high risk, you will be able to eat and move throughout this process, however, monitoring is consistent throughout this process. Once the Pitocin has begun to contract the uterus, sometimes your body will take over and they are able to shut the Pitocin off, and other times it increased at steady intervals usually every 30-60 min. This is when we are dilating the cervix.

There are risks associated with induction, however, as in most hospital interventions, the benefit can outweigh the risk depending on your individual situation. Some of the risks can be a failed induction. According to Mayo Clinic, about 75% of inductions are successful vaginal births, and the remaining 25% result in a c-section. We could see a low fetal heart rate from the medications used during the induction. There is a rare but serious complication of uterine rupture, and lastly the risk of more serious bleeding which usually occurs due to the medications.

I have been seeing inductions suggested much more than I have seen in the past, and I think people need to be aware of how it is done, and some of the risks that could be involved. More often than not I am seeing inductions suggested with not enough clarity and understanding. It is a process, and a process that can sometimes be beneficial to both the birthing person and the baby, just make sure to ask all of the questions and understand that induction is not easier or shorter. It is sometimes being sold as a quick fix, and honestly, there is nothing quick about it.

Here are a few questions to ask if your provider suggests an induction.

1. Why do I need an induction of labor?

2. When is my due date?

3. Do we have other alternatives, including waiting?

4. What percentage of patients in your practice are induced?

5. How will an induction change my birth plan?

6. When are you wanting to induce?

7. What will you be using to induce?

8. What is my Bishop Score?

9. What are my options if it isn’t working or progressing?

10. What are the risks?

I think that if an individual goes into any medical procedure with our questions answered, and being heard, we will feel a lot more confident and trusting. Remember an induction is not a guarantee to C-section. I have been at many inductions that ended in a vaginal delivery. I just want to make sure that you understand the process and know how to get answers.

XoXO-HOlly