Tag Archives: prenatal care

My Top Prenatal Care Tips After 5 Pregnancies

Trying to Conceive

Focusing on your physical health prior to trying to conceive (preconception) is a really important, often overlooked step in the prenatal process. Experts often recommend focusing on improving health habits for a minimum of 3 months prior to trying for a baby. This is a great time to focus on nutritious foods, taking daily prenatals, limiting alcohol, exercising in moderation, reducing stress and participating in joyful activities. Preconception health is important for BOTH partners and has been shown to reduce preterm birth and low birth weight for babies. I focused intently on preconception health for all of my pregnancies except the one where I had a late pregnancy loss after a poor prenatal diagnosis. Although I was still leading a healther-than-average lifestyle, I will always wonder if there was something I could have done differently. I’m told that none of what happened was my fault and I’ve let go of guilt. Nonetheless, I wish the dawn of the coronavirus pandemic hadn’t derailed my health habits to the extent that it did.

Dropping expectations and timelines for TTC was critical every step of the way for all 5 of my pregnancies. It’s all too easy to compare your TTC experience to another woman’s but there’s no measuring stick when it comes to starting and growing a family. Stay focused and loving towards yourself and your partner. That’s all that matters.

In a similar vein, I encourage women to embrace the fact that every couple’s parenting journey is unique. Sometimes you will find yourself envying a friend or acquaintance’s circumstances only to find that a couple years down the line they face something harder than anyone you know. None of this should make aspiring mothers or mothers feel better or less than someone else. Dropping comparison games is one of the first lessons most new parents learn. Doing so is critical for a family’s well-being, and it begins before a baby arrives.

Try not to get into your head about “advanced” maternal age or prior pregnancy experiences. Preconception health can help many women healthfully conceive babies in time, and the level of reproductive assistance needed may wildly vary from one pregnancy to the next. I know of women who conceived quickly for their first pregnancies only to have long waiting periods for their subsequent ones. Likewise, I know several women who needed IVF to get pregnant the first time and then went on to surprisingly conceive other babies naturally. You may find that every time TTC is different. That’s okay! Just stay focused on your mental/physical well-being, the relationship with your partner, and seeking fertility advice when/where needed be that from an app, ovulation predictor kits, a fertility clinic consultation, a conversation with an OB, etc.

Speaking of ovulation predictor kits…I know they can be expensive so take this or leave it… but I found that investing in them for periods of time significantly helped me discern which physical symptoms of mine were related to ovulation, as well as get a handle on the timing of it. I understand these sticks can cause some women stress while empowering others with a feeling of control. My advice is that if you can afford to give them a try then it can’t hurt to use them during your preconception period to figure out your cycles and peak fertility days. This might help you learn something about your body while you’re not actively trying for a baby, thus reducing stress over the whole ordeal.

First trimester

It goes without saying that frequent snacking is crucial for first trimester nausea. I learned this and relearned this many times.

During the first trimester of my 4th and 5th pregnancies I was stunned by how exhausted I was, especially because my other pregnancies didn’t carry the same weight of fatigue. I took frequent naps, deciding to accept my body’s needs. As a type A person, this was challenging because I always had to sacrifice or cut short something I was trying to get done. My two cents in retrospect – drop the guilt and sleep if you need to.

Whether due to nausea or fatigue, the first trimester can feel like it drags on forever. Remind yourself that this will be worth it. Stick inspirational notes on your desk or schedule motivational memos to pop up on your phone. Have a weekly check-in with a friend or therapist. Whatever it takes!

Nausea with my girl pregnancy was a different beast than my many boy pregnancies. Frequent snacking wasn’t helping as much as in the past so I opted for these nausea sea bands. I found that putting them on took the edge off the nausea and that wearing for them for long periods of time seemed to bring it back, so I spent a lot of days slipping them on and off as needed. It was life saving!

Weight gain is perfectly normal in the first trimester but it’s important for women to remember that the focus on weight gain doesn’t typically come until the second trimester. Unless you’re underweight or directed otherwise by your OB, focus on eating as normally as possible (and to relieve nausea) without going overboard on portions, sweets, and greasy foods. One study found that women who were a healthy weight before getting pregnant were overweight one year after their baby was born. A lot of this can be attributed to the challenges of caring for a baby but for some women gaining more than the recommended amount of weight for their size during pregnancy might contribute to it.

When possible (ahem, energy permitting) work on building core strength during the first trimester. This is a time when most core exercises are still fair game. Beginning in the second trimester, women will need to modify a number of core exercises so take advantage of building a strong base from the beginning so that you can safely maintain the support your body needs for posture and protection from diastasis recti as the pregnancy progresses. As a fitness professional, core exercises are top priority for my prenatal clients!

Early Pregnancy Loss

If you experience an early pregnancy loss please know that you have my deepest condolences. I’m so sorry this happened to you. I’ve been there and it sucks. Please know that you’re allowed to validate any and all feelings of disappointment, anger, grief, shock, etc. that you may have. Science shows us that denying negative feelings can actually heighten stress in our bodies so take the time you need to face and move through these tough emotions.

Know that it’s okay and normal to feel a loss of innocence about pregnancy and its supposed “bliss.” If you don’t have a friend who can speak to you candidly about their own pregnancy loss experience(s) then consider one of these books:

If it helps (which it may not), remind yourself that you’re not alone. Other women have struggled through pregnancy loss(es) and are slowly speaking up on social media in particular, in hopes of helping one another. If it’s not triggering, you can check out hashtags such as #iamoneinfour, #pregnancylossawareness, #pregnancylosssupport and #ihadamiscarriage, to name a few.

Your timeline for trying again (or not) is valid. Do what you need.

Second Trimester

If possible, tackle house projects and bigger baby projects now while you have some energy. It can be hard to frontload task lists that feel so distant in the future, but it’s worth it. With my first pregnancy, I was relieved to have done this because I had an unexpected family death and a preterm delivery that needed my attention more than folding laundry, prepping the nursery, and finishing house projects.

Healthy eating while gaining weight is important for the baby’s nutrition and your own, and for reducing the risk of gestational diabetes. My advice is to balance carbs and protein. In other words, be cautious not to sit down and eat tons of breads/muffins/baked goods without incorporating some protein in the same meal setting.

Our bodies have an intuitive ability to know how much weight we need to gain. Instead of calorie counting, try to listen to your body’s unique prenatal needs. I’ve personally found it fascinating that all three of my pregnancies have resulted in more or less the same weight gain and pacing of weight gain simply by eating what my body seems to be telling me to. During my first pregnancy I weighed myself once a week but in subsequent ones I backed off the scale and found a similar pattern of weight gain nonetheless!

Some of my favorite prenatal exercises for both myself and clients include: clamshells, single leg balance exercises, modified planks, single arm bench rows, squats, side lunges, and modified v-sits.

Towards the middle to end of your second trimester you will need to complete a glucose screening to asses your personal risk for gestational diabetes. Most women think they have no option but to go into the OB’s office and drink a highly processed sugary beverage with zero nutritional benefits. But guess what?!? You can speak to your OB about consuming a healthier beverage option at home with the proper grams of sugar (usually approx 50 grams) in five minutes, one hour prior to your blood draw. I’ve done this for two pregnancies and really appreciated that the beverage was both more palatable and nutritious. One time I had acai juice and the next I chose pomegranate juice. After quickly drinking 12 or so ounces it was done, less dramatic feeling, and I was still in the comfort of my home.

I recommend going to a chiropractor as your body and alignment begin to shift. Chiropractic care is safe for pregnant women, can help your baby achieve an optimal position for birth, and reduces postural stress and aches/pains for the mom.

Unexpected Medical Complications

I sat in this very challenging space following my third son’s poor prenatal diagnosis and was surprised that my gut instinct had been speaking to me the whole pregnancy. It can be hard to quiet the overwhelming news and whirlwind around you amid a poor prenatal diagnosis but if you can, try to sit in silence and listen to what your maternal instinct is telling you.

Lean into support groups, spiritual counsel, prayer, therapy and/or any other safe outlet for help during this complicated and uncertain time.

Engage in “flow” activities to help you maintain a semblance of balance and mental health while you’re waiting on uncertain answers from medical screenings/tests, etc. These daily activities have been scientifically proven to help people with the psychological challenges of uncertainty.

Spend time having heartfelt conversations with your partner. You two are a team and will come out of this together one way or another.

Whatever happens, you get to create your own meaning from this experience. You also don’t have to seek a “higher purpose” to understand your pain if that feels inappropriate. Do what feels authentic to you and no one else.

Late Pregnancy Loss

As with early loss (I’ve been through both early and late), this is a child you were expecting and who you need to – and are allowed to – grieve. Please refer to the book recommendations under early pregnancy loss and consider working with a supportive counselor.

You’re allowed to be upset, angry, confused, disappointed, etc. about losing your baby, coping with a postpartum body, the change of plans you had for your future and more. Take the time you need. There’s no rush or timeline for healing.

If you feel compelled, I encourage you to consider meaningful ways to honor your baby. Some communities offer free burial or ceremonial options, cremation, or the option to dedicate your baby’s body to science. Choosing something that offers you solace and closure can be helpful. I chose to bury my baby and find comfort in returning to his resting place. I know of other women who light candles for their babies and keep their ashes in their homes. For others, these reminders might feel too painful or not quite right. Whatever honors your needs is what will honor your baby.

Rituals can help women with healing through the seasons and years that follow loss. Lighting candles, donating to a cause, visiting somewhere sentimental, meditating or praying, etc. are all ways women can foster meaning and remembrance for their babies.

Some women find they prefer to create meaning through something tangible like symbolic jewelry, journaling or expressive art. I have a small canvas of an angel on my dresser alongside my other children’s framed photos.

Healing and expressive outlets are important and you might find one of the following useful: therapy, prayer, reiki, community worship, online or in-person support groups, etc. It can be intimidating to open yourself up to these but please remember that there isn’t any stigma to your loss and that you don’t have to carry it alone.

Third Trimester

Sleeping with a body pillow or multiple prop pillows is a must. Since side sleeping is your new BFF try sleeping with a support pillow between your legs and gently tucked under your bump. This will help your hips stay comfortable as muscles stretch and pull. Keeping your room cool at night is another must for better late pregnancy sleep.

Stabilizing your hips through a combination of exercises and stretching is crucial for comfort. An overwhelming 50-80% of pregnant women struggle with back pain. A lot of back pain originates from hips that aren’t stable and strong. If you have questions or specific needs, this is my area of specialty for prenatal clients. Contact me here or drop a question in the comments.

Neck tension is also quite common as pregnancies progress. Try to seek relief via massage and stretching. Here are some of my recommendations for alleviating neck tension: Remedies for Neck Pain and Stiffness.

I was fortunate that I didn’t need a belly band for my pregnancies with my two sons but since my complicated pregnancy loss and emergency c-section last year, my body isn’t quite the same. The scar tissue stretched out fast this time and my stomach doesn’t feel as supported. Instead of investing in an expensive belly band for the last uncomfortable month of pregnancy, I’ve found that using KT tape here and there has been effective and easy! Fellow fitness blogger Sia Cooper, owner of Diary of a Fit Mommy, has done such a comprehensive job covering 8 techniques for KT tape on a pregnant belly that I’m just gonna refer you to her post rather than try to cover the topic myself: Kinesio Taping During Pregnancy.

Many of my prenatal clients (and friends) accidentally engage their core in a precarious manner during the third trimester of pregnancy. As soon as bumps start to really round out and show, it becomes even more obvious (to me) who is not engaging their transverse abdominus. The TA is like a corset muscle that holds everything in, supports posture, works with the diaphragm, and is critical for preventing diastasis recti injuries during pregnancy. The next time you’re doing core exercises look down at your stomach and make sure you don’t see a “coning out” effect. Your stomach should pull in and “flat” near your belly button when you’re engaging it in a safe and effective manner.

During the third trimester your immune system is naturally overtaxed. Help your immune health with colorful fruits, vegetables, omega fatty acids (ex: salmon, shrimp, flaxseed, walnuts) and lean proteins.

Hydration is critical during the entire pregnancy but especially now. Some women need upwards of 100 ounces of water a day during the third trimester. I personally notice that my uterus gets “irritable” and more prone to Braxton hicks contractions when dehydrated – it’s my cue to drink up! Hydration can be made easier if you carry a 30-32 ounce tumbler or water bottle throughout the day and fill it up at least three times. This Yeti tumbler is a personal favorite.

The third trimester is full of “lovely” changes like extra mucous, nose bleeds and head congestion. I do a daily neti pot rinse while I’m showering to help move congestion and keep breathing clear. Give it a try!

It can be hard to reduce stress while expecting, especially amid a pandemic. But every so often, I manage to remind myself (and hope to remind you too) to take a few deep belly breaths. Inhale: I’m strong and capable. Exhale: This phase will be over soon.

Every woman is worthy of care and support during preconception planning, TTC, pregnancy, pregnancy loss, medical complications, childbirth, postpartum, breastfeeding, childrearing and childcare. I’ll be here if you need me.

Yours in health and wellness,

Maggie

What I Did Differently in My 2nd Pregnancy (and why)

Preterm labor

*All information in this section is quoted directly from the March of Dimes.

Definition: Babies born before 37 weeks.

According to the March of Dimes, signs of preterm labor in a pregnant woman may include:

Change in your vaginal discharge (watery, mucus or bloody) or more vaginal discharge than usual
Pressure in your pelvis or lower belly, like your baby is pushing down
Constant low, dull backache
Belly cramps with or without diarrhea
Regular or frequent contractions that make your belly tighten like a fist. The contractions may or may not be painful.
Your water breaks

A few of the top risk factors for preterm labor include:

You’ve had a premature baby in the past.
You’re pregnant with multiples (twins, triplets or more).
You have problems with your uterus or cervix now or you’ve had them in the past.

Medical risk factors before pregnancy for preterm labor and premature birth:

Being underweight or overweight before pregnancy. This can include having an eating disorder, like anorexia or bulimia.
Having a family history of premature birth. This means someone in your family (like your mother, grandmother or sister) has had a premature baby. If you were born prematurely, you’re more likely than others to give birth early.
Getting pregnant again too soon after having a baby. For most women it’s best to wait at least 18 months before getting pregnant again. Talk to your provider about the right amount of time for you.

Coming home from the hospital with baby #1 (my son Carter)

Things I Did Differently in My Pregnancies

Although I did a lot of things differently in my second pregnancy, there are a few things I did the same that I feel are worth mentioning first. In both of my pregnancies I avoided smoking and alcohol. Some moms feel like by the third trimester the baby is “fully baked” and an occasional glass of wine or beer won’t do any harm. I can see the logic, and to each their own, but I feel that the evidence regarding baby brain growth accelerating in the third trimester (the brain triples in weight!) is enough to confirm that I don’t want to flirt with any toxins beyond an occasional “taste sip” of someone else’s beverage.

In both pregnancies I followed a healthy diet, eating plenty of fruits, veggies, lean proteins and healthy fats (plus a daily sweet indulgence after dinner!), and maintained an exercise regimen focusing on lots of hip and core stabilization. Lastly, as is my nature, I nested like a crazy person both times. My husband may be experiencing PTSD from my latest “honey do” list that had him scrambling up ladders, re-caulking our kitchen, and car shopping for a new vehicle.

The things I did differently the second time I was pregnant were primarily actions driven by the desire to avoid another preterm labor. As mentioned, it’s impossible to say whether these actions influenced my body’s ability to get to full-term this time around or if I was always going to have a second baby at full term. Either way, these natural approaches to preventing preterm labor are ones any woman can incorporate into her prenatal care after talking to her OB about her personal risks for preterm labor and whether or not progesterone shots are strongly encouraged for her…

C-Reactive Protein

This protein can be high in a mother’s bloodstream because of acute or chronic infections, and may be the reason why women with urinary tract infections during pregnancy are more susceptible to preterm labor. C-reactive protein is a marker of inflammation but it can be lowered and controlled by a Mediterranean diet, adequate vitamin C, and probiotics. Hence, I tried to eat fruits higher in vitamin C during my pregnancy (kiwi, strawberries and citrus), started a new, higher CFU probiotic designed for prenatal health, and made sure that I ate the maximum allowance of low-mercury fish for pregnant women alongside other healthy fats like nuts, flax, avocados and olive oil.

Omega 3s

There is some evidence that an increase in Omega 3 fatty acids can help reduce the risk of preterm labor primarily thanks to their effect on balancing prostaglandins (which help the cervix ripen in preparation for labor and help the uterus contract – hence a better balance of this hormone would do the reverse and slow down physical preparations for labor). Thanks to this research, I made sure to bump up my Omega 3s, starting with adding a serving of ground flaxseed to my morning oatmeal.

Mega-Hydration

Uterine irritability can be triggered by dehydration. I was informed of this when I went in to the labor and delivery unit at 24 weeks with pregnancy #2. I was throwing up uncontrollably thanks to a virus that my toddler and husband had been ill with just a couple days prior. They only suffered a fever and lack of appetite whereas my body went into full-blown chaos; fever, chills, violent vomiting, etc. While I was getting treatment for an anti-nausea medication at the hospital the nurses hooked my belly up to monitors to assess potential contractions. Extreme dehydration can throw some women into preterm labor or labor because uterus begins to experience contractions. My belly wasn’t contracting in full but it was “irritable” – aka experiencing an abnormal amount of tightening that could potentially progress to contractions. The nurse who was caring for me sent me home with one of those giant hospital cups that has a handle and straw, and that holds up to 32 ounces when full. She told me to drink 3-4 of them a day in addition to my other beverages. I was a bit shocked by the volume but took it to heart and can say with certainty that I stayed better hydrated in my second pregnancy than my first. (Summary: To prevent uterine irritability and contractions drink at least 10-12 cups water/day.)

Coming home from the hospital with baby #2 (my son Colby)

Dental Health

Believe it or not, it’s true; challenges in dental health (ex: gingivitis) can contribute to preterm labor. Say whaaaa? Yup, bacteria from the mouth actually migrates to the placenta and can cause inflammation that can trigger preterm labor. Most women who experience a direct correlation between poor dental health and experiencing preterm labor are women who haven’t had proper dental care, but that being said, it never hurts to cross your T’s and dot your I’s. This is why, despite not having any former dental problems, I became extra diligent about brushing my teeth for a long time and flossing each day during pregnancy. Admittedly, my flossing habits were in need of some improvement.

No High-Intensity Interval Training

We’ve known for a while that exercise can impact hormones. It helps women who are estrogen dominant become more balanced and it releases feel-good hormones like endorphins. Men and women benefit from a boost in testosterone during exercise too. Changes in body composition in response to exercise bring additional benefits for the endocrine system. As it turns out, progesterone is yet another hormone that can be impacted by exercise…more specifically, it can be lowered by high-intensity interval training (HIIT).

During my first pregnancy I did a couple HIIT workouts each week – it was my jam. I always kept my heart rate within safe ranges and I knew how to modify high-impact and intense exercises for safety. It felt like I was doing no harm. In retrospect, maybe that kind of exercise wasn’t the best. If nothing else, it didn’t kill me to put it on the back burner during my second pregnancy, plus I think my pelvic floor enjoyed a rest from high-impact moves – and for that, my body is already saying thanks (and I’m only 2.5 weeks postpartum!).

Lowered Physical Stress

Studies show that women who spend 5+ hours on their feet each day are at a higher risk for preterm labor. This is a tough pill to swallow for a busy body like myself who works in fitness. With this knowledge in my back pocket, I worked to lower physical stress during my second pregnancy. I took more naps and got off my feet when I was fatigued instead of powering onward in my stubborn determination to get stuff done. It was difficult to discipline myself at first but with a toddler to care for, this may have ended up becoming my saving grace.

Delayed TTC

Women who wait 18 months from giving birth to one child to conceiving another are at less risk for preterm labor. In other words, any woman who gives birth to or gets pregnant with subsequent children in under 1.5 years is at a higher risk for a preterm baby. Hence, I took my time gradually weaning my son around a year and a half old and let my hormones stabilize for a few months before jumping into the TTC roller coaster for the second time.

Right to Refuse Internal Prenatal Checks

It’s hard to feel like we have a right to deny basic prenatal routines like internal cervical checks in the third trimester – but as mothers, we totally can reserve that right! You have full control over the process and no one can force you to do something you’re not comfortable with. I was thrilled when I told my OB that I was concerned internal checks might cause my water to break early again (it broke a handful of hours after an internal check in my first pregnancy). Thankfully, my OB understood my concerns and said that internal checks don’t do a lot for most of the third trimester except satisfy curiosity. I was blissfully in the dark until 39.5 weeks when I got my first check and discovered I was already 4 cm dilated! (So *that’s* what the random back pain and cramps were at 38 weeks – early labor contractions!).

Visualization

I’m not sure if there’s any science to pointing to visualization helping you get to full-term in pregnancy but I will hang my hat on how a difference in my mindset facilitated a healthier and longer pregnancy the second time around. I was so anxious and ready to be “at the end” in my first pregnancy. Perhaps that caused me to have higher inflammation, push harder, ask for more internal checks and more. There are a number of ways this could have caused me to treat my pregnancy differently. I’m so glad that I wanted nothing but to be extremely (even painfully) pregnant instead of having a preterm baby in my arms. This mindset drove small daily actions that I believe added up and helped me achieve a healthy pregnancy.

I did a few other things differently in my second pregnancy too, like avoiding most decaf coffee brands due to how the beans are decaffeinated using chemical solvents and requesting that I be allowed to drink an organic fruit juice drink for my prenatal glucose screening instead of that nasty, unhealthy orange drink they offer in the office. I also stood my ground in labor and delivery, electing to avoid pitocin and an epidural and marveling in shock (and pain) when my natural labor efforts jumped me from 6 cm dilated to 10 cm in one contraction (in a warm bathtub!).

It wasn’t always comfortable trying to do things differently for my second pregnancy but it was well worth it (just check out the sweet, healthy glow of my full-term baby boy Colby!).

Worth the wait for this little sweetie

(Please forgive any typos…still only a couple weeks postpartum over here! See y’all in a few months for some fresh content…okay…maybe even longer…we’ll see how mothering two headstrong boys shakes out.)