Follow me through my pregnancy
This series is going to be extremely personal. I’m inviting you to walk along with me for this pregnancy. I’ll share portions of my journey, as a midwife and mother.
Each week I will add new updates and content. Scroll down to see the weekly articles.
Disclaimer: my choices are mine and are in no way medical advice. You should always speak to your trained and trusted maternity provider if you have questions or while developing your own plan. This series is for story telling purposes and reflects the decisions I’ve made considering my history, personal preferences, and philosophy.
Weekly Pregnancy Post
7 weeks
I am writing this post a little late now that I’m 8 weeks and 2/3 days. Next time I’ll share the excitement that 8 weeks and 0 days brought, but you’ll have to stay tuned.
Week 7 brought quite a bit more nausea. No vomiting at this point, but lots of gagging and retching. At least I don’t have to worry about dehydration! (Got to find that silver lining.) Though absolutely no food is enjoyable right now, some foods are more tolerable. Generally carbs are easier to manage, but other things are not always logical on the surface. For two days the only food that seemed approachable was basmati rice topped with kimchi. Pregnancy is weird. In a delightful outlier, one morning an everything bagel with smoked salmon, avocado, and cream cheese was actually pretty nearly enjoyable! Seek out protein however you can tolerate it, but just survive. Hydration is helpful, and electrolytes in hydration are good too. Granted, most of the time it may not be tolerable to drink a whole glass of fluid in one sitting, but rather sip throughout. I also have found decent help in the vitamin B6/ginger candies. The moral of the story here is do what you can.
Let’s shift gears and talk about starting care and what kind of provider options there are for people seeking maternity care by a trained provider. Two main categories are physician and midwife. In each of these there are a number of subtypes. For physicians, there are obstetricians and family practice physicians, though obstetricians are far more common than family practice physicians. In the USA, the vast majority of people receiving maternity are getting their care from obstetricians. This is different from many other developed nations where the majority of people are getting care from midwives, and higher risk pregnancies are cared for by obstetricians. For midwives, there are several options as well. Nurse Midwives (CNM,) are recognized and licensed in all 50 US states. Professional Midwives (CPM) are nationally credentialed and many states provide licenses for CPMs, though not all. Certified Midwives (CM) are more akin to CNMs, though without the nurse background, but CMs are also only licensed in a handful of states. Finally there are traditional midwives. This is the oldest style of midwifery training that usually has a long apprenticeship model and is how midwives have trained for thousands of years. (Yes, the midwives of the Bible were traditional midwives.) We are going to go into more detail about each.
Obstetricians are physicians who are trained in medically managing maternity care and perform surgery like cesareans. They almost always work in a hospital setting. If there is a medically complex pregnancy, it is likely that an obstetrician is going to be the best type of provider to manage the medical care of the pregnancy. Certainly, if cesarean is warranted, an obstetrician is going to be the best provider type. Of note, there is a specialty type of provider called Maternal Fetal Medicine, MFM, who is a high risk pregnancy specialist. Typically, MFM work in conjunction with a primary maternity care provider- both midwives and physicians- and do not attend births. It is estimated over 85% of pregnancies in the USA are cared for by an obstetrician. Obstetricians have been around since the 1800’s. There is a whole interesting history of obstetrics taking over the majority of maternity care from midwives, but that is beyond the scope of this post.
Family Practice providers are physicians who are primary care providers for all ages and sometimes also provide maternity care. Recent data indicate that nationwide, about 7% of family physicians report attending births, but in rural counties, 17% of family physicians report attending births. Reports indicate most family practice providers who do attend births, are usually less than 25 births per year.
Certified Nurse Midwives, CNMs, are licensed in all 50 states. To quote my alma mater, Frontier Nursing University;
“A Certified Nurse-Midwife (CNM) is a primary health care provider to women of all ages throughout their lives. CNMs focus on gynecologic and family planning services, as well as preconception, pregnancy, childbirth, postpartum and newborn care. They also provide primary care such as conducting annual exams, writing prescriptions, and offering basic nutrition counseling.
Certified nurse-midwives are advanced practice registered nurses (APRNs) backed by the American College of Nurse-Midwives. To become a CNM, registered nurses must graduate from a master’s or higher-level nurse-midwifery education program accredited by the Accreditation Commission for Midwifery Education (ACME) and pass the national Certified Nurse-Midwife Examination through the American Midwifery Certification Board. All CNMs must hold state licensure.”
Most CNMs work in a hospital setting, though according to recent data, there are growing numbers who work in out of hospital settings attending community births, like me!
Certified Professional Midwives, CPMs, are direct-entry (meaning non-nurse) midwives certified through the North American Registry of Midwives (NARM). They specialize in out-of-hospital births and are trained through MEAC-accredited programs or the Portfolio Evaluation Process (PEP). They emphasize natural birth and low-intervention care, typically attend home births or work in freestanding birth centers, have legal recognition in 30+ states, do not have prescriptive authority, and often work independently or in midwife-led teams.
A CM (Certified Midwife) is a non-nurse midwife who completes a graduate-level midwifery program, passes the same national exam as a CNM (Certified Nurse-Midwife), and provides comprehensive women's healthcare, but unlike CNMs, they don't have a nursing background, though they offer similar services in states where licensed (like NY, NJ, CO, MD). They focus on pregnancy, childbirth, postpartum, and gynecological care, working in hospitals, birth centers, and homes, with their scope defined by state laws. The CM credential was developed in 1994 in order to expand access to midwifery through multiple educational pathways.
If you prefer, there is a handy, though bulky, chart helping to underline the similarities and differences of CNM, CM, and CPM. Comparison of Certified Nurse Midwives, Certified Midwives, and Certified Professional Midwives
Then, of course, there are traditional midwives. A traditional midwife provides pregnancy, birth, and postpartum care based on ancestral wisdom, community experience, cultural practices, and traditional learning (like apprenticeships.) They view birth as a natural process, a ceremony, not a medical event. They often serve rural or underserved areas with personalized, family-centered support and do not carry formal medical credentials like those of CNMs/CMs. They offer culturally relevant care, often speak local languages, and allow family presence but generally are limited in ordering labs/imaging or file birth certificates like certified professionals, and do not have prescriptive authority.
In general, physicians are taught that pregnancy is a medical condition that requires medical management. Midwives are taught that pregnancy is a normal physiologic event that can become medically complicated. There is even yet another option- choosing to have no trained birth attendant, a “free birth.” Admittedly this option makes me nervous, but I believe people should have the right to choose that option as well, as long as they are fully informed of the pros and cons.
There’s a whole layer of discussion about the pros and cons of choosing a licensed vs unlicensed provider and much of it can depend on the regulations of licensure in the state and the priorities of the family seeking care. For example, some states have extensive regulations around licensure and can often limit the scope of practice significantly more than full scope of practice allotted by the licensing board. This is decidedly a downside in many cases. Thankfully, where I live in CT, the parameters put on me by my license are quite minimal and I do not feel that they limit my ability to practice to the extent of my license. In CT, I am legally required to submit a birth certificate for any births I attend. In other states like CA, licensed midwives are not legally permitted to care for breech babies, multiples, pregnancies beyond 42 weeks, cannot perform ultrasound, and more- even if their training encompasses these aspects of care. In Nebraska, Certified Nurse Midwives (CNMs) are effectively prohibited from attending home births, as state law allows only physicians to attend, and physicians in Nebraska generally do not provide this service, making it a felony for CNMs to attend home births! (Like, what country are we even in!?) Because of some of these egregious limitations on licensed providers, there is a whole underground movement for unlicensed providers in states where laws severely limit people’s choices.
It is also worth mentioning that many people have or are developing serious aversions to the medical industrial complex as they find the whole system corrupt and want to distance themselves from an industry that is frankly founded in some pretty icky stuff ethically. There are families who purposefully seek out a maternity care provider who was never part of the modern medical system, like a traditional midwife. There are differing opinions from those within the medical system that are aware and disgusted by the rampant corruption in the medical system about whether it is better to try to fix/alter the system from within or eschew the system altogether and operate in an entirely separate system. Again, this topic is so deep that I can’t possibly do it justice in this blog post.
As people are seeking a maternity care provider there are many factors that go into the decision making process; location of birth, affordability, training, autonomy, legal parameters, cultural practices, medical history, and much more. I personally believe there is a situation for each provider type and if people have access to all provider types based on their needs, the whole system works together better. Our country needs to do a much better job with integration of the different provider types and birth settings. I encourage people to evaluate their vision for their experience and evaluate the options in their area. Thankfully, even if care is started with a provider that does not feel like a good fit, you do NOT need to stay with someone you do not feel comfortable with. This goes for maternity care, pediatric care, primary care, and so on.
As many people are starting prenatal care around 8-10 weeks, I encourage people to consider their options. Your pregnancy is yours.
Thanks for reading! Until next time.
6 weeks
This week was week 6 (meaning conception occurred approximately 4 weeks ago.) A very common practice in the USA is for a medical provider to order an ultrasound at 6-8 weeks of pregnancy. There are a number of reasons for this ultrasound, and a number of reasons (in my opinion) to decline this early ultrasound. The primary reasons to consider a 6-8 week ultrasound are “dating and viability.” Basically, “is the pregnancy as far along as we expect considering your last menstrual period (LMP)? And is there a heartbeat?” If there is a question about either of these, the benefit of an early ultrasound may be worth potential risks. For example, if someone is unsure about their LMP, or if they have irregular cycles, and they don’t track ovulation with cervical mucus/basal body temperature or hormonal tracking technology, having a better idea if you are 8 weeks vs 4 weeks would make a difference in caring for the pregnancy appropriately. However if it is a question of am I 6 weeks and 1 day or 6 weeks and 3 days, it essentially doesn’t matter. Estimating gestational age is nearly always an estimate unless there was assistive reproductive technology like frozen embryo transfer or similar. Even if you know exactly when you were intimate with your partner, fertilization/conception could have happened up to 5 days later! And even if you know when ovulation occurred and there was only one episode of intimacy in the fertile window, there are still fluctuations between fertilization and implantation.
Quick vocab:
Fertilization: fusion of the male and female gametes, when the sperm joins the egg to become one cell. This is when the haploid genetic information (DNA) from the sperm and the (haploid) genetic information (DNA) from the egg join together to make a new unique complete set of human DNA, the complete blueprint to the new human. This new cell with complete DNA is now termed blatocyst.
Implantation: the attachment of the fertilized egg or blastocyst to the lining of the uterus
Anyways, as I was saying, there is variation in the time from the first day of the last menstrual period to ovulation, from intimacy to fertilization (up to 5 days before fertilization,) and from fertilization to implantation (6-12 days.) Especially when women are not comfortable with reading the signs of ovulation or tracking their data, it can make the dating of a pregnancy a little hazy. However, many women are becoming more familiar with tracking their cycle and becoming in tune with what is going on with their biology and can say with good accuracy the estimated time of conception. Especially for people who practice cycle tracking using a sympto-thermal method, there is good accuracy for timing of ovulation. Ovulation is interesting because the egg only hangs around for 12-24 hours! It is a limited time deal. Either it is going to get fertilized and work on growing a baby or its going to pass on and no pregnancy this cycle.
I give what probably feels like too much backstory here to understand the reasons for why someone may want a dating and viability ultrasound. Dating is what I have focused on so far. Again, if we are “off” by a couple days, sort of who cares, because the estimation of the “due date” is also very much an estimate. (Much) more on this topic later. So, if we have a good idea when conception occurred, then we already have dating pretty well established in most cases. Now let’s talk viability.
Viability refers to the ability of the pregnancy to continue. If there is no heartbeat by 6+ weeks, unfortunately the pregnancy is no longer viable. If a blastocyst has implanted outside of the uterus, like the fallopian tube, this is also not a viable pregnancy.There are definitely some complications that can arise in this time frame that would benefit (or require) intervention. However, most of the time, if there is not a viable pregnancy it does not require intervention unless there are other clinical signs that would indicate otherwise. For example, if someone is experiencing pain or bleeding, this would indicate to me as a midwife to do some investigation to assess for some of these potential complications.
But what if everything is normal? If a woman is tracking her cycle, knows when she ovulated, is having normal signs of pregnancy, especially if she personally prefers to avoid ultrasound- there is not a good clinical indication for insisting on an early ultrasound. Now, why might someone not want to get an early (or ever) ultrasound. I’ll try to discuss this briefly.
There are concerns with the safety of ultrasound, especially in the first trimester. The first trimester is well established to be the most crucial in development (we are in the organogenesis phase- organs are all being formed!) and are the most sensitive to dangers. A quote from the FDA:
“Although ultrasound imaging is generally considered safe when used prudently by appropriately trained health care providers, ultrasound energy has the potential to produce biological effects on the body. Ultrasound waves can heat the tissues slightly. In some cases, it can also produce small pockets of gas in body fluids or tissues (cavitation). The long-term consequences of these effects are still unknown.”
Now a quote from The American Institute of Ultrasound in Medicine (AIUM): “Some studies have reported effects of exposure to diagnostic ultrasound during pregnancy, such as low birth weight, delayed speech, dyslexia, and non–right-handedness. Other studies have not demonstrated such effects.” It is important to understand that science is almost never settled. We are constantly learning new things that make us cringe about what we did before we knew better. (Smoking in pregnancy and thalidomide to name a couple.) Studies in pregnancy, and especially on noncommon outcomes are very difficult to make conclusions as each study is just a data point, not the whole picture. The body of evidence at this point suggests that using ultrasound minimally and for specific reasons produces better outcomes than using them multiple times throughout the pregnancy “just in case” or not using them at all.
For me, I track my cycle. I know when I ovulated. I have had no concerning signs in this pregnancy to date. There is no reason I need to get an early ultrasound. So, I opt not to. Don’t get me wrong, it might be nice to see what's going on in there. I’d love to see a little heartbeat. I’d love to confirm how many babies. But I am not filled with anxiety about it, or have any true concerns. I believe however, if someone is beside themselves with worry about their pregnancy, it is a more holistic approach to consider an early ultrasound to hopefully set their mind at ease. For me, the curiosities I have can wait. Nothing requires my intervention now. Pregnancy is an excellent opportunity to practice patience. OOOoook, enough on that already.
For those with specific curiosity about sex of the baby, there are now tests that can detect fetal chromosomes as early as 6 weeks. There are several who advertise this ability, so I’ll not name names since they don’t need free advertising. How is this test done? It actually is very simple once you understand a really stinkin’ cool bit of science. So, even this early, baby’s chromosomes are floating in mama’s blood. Not baby’s whole cells, because then our immune system would recognize the substance as foreign, but just little bits of their DNA. (We now know that some of those bits stay around for a lifetime! Small parts of your baby- or babies- stay with you forever.) There is a medical screening blood test that can be done after 10 weeks gestation which looks for a wider range of genetic information, but I’ll talk about that more later. These early sex predictor tests only rely on the fact that the baby's DNA is already present in the maternal blood circulation, and looks for a Y chromosome. (Remember, XX is genetic for female, and XY is genetic for male.) If a Y chromosome is present, the result is, “it’s a boy!” and if no Y chromosome is found, “it’s a girl!” This is surprisingly accurate, and the tests advertise >99% accuracy when testing after 6 weeks. There can be contamination from any male in the room though, so careful sample collection is important. I usually am one that loves a surprise as far as boy baby vs girl baby. However, this time I felt called to take the test. So I am currently awaiting my results.
As far as the actual experience of the pregnancy at this point, it feels appropriate to discuss the infamous symptom of nausea. It is such a quintessential symptom that in any book, show, or movie, if a woman is suddenly nauseated, it might as well be a positive pregnancy test. Thankfully, for them, not everyone experiences nausea in pregnancy. It is estimated that 70-80% of people experience nausea in the first trimester and 1-3% of people may experience severe nausea and vomiting known as hyperemesis gravidarum (HG.) HG is a severe form of nausea and vomiting of pregnancy that is dangerous to mom and/or baby due to the severity. These miserable people are vomiting multiple times per day, sometimes up to 20-50 times per day! It is characterized by persistent vomiting, significant weight loss (typically ≥5% of prepregnancy weight), dehydration, and metabolic disturbances and is a leading cause of early pregnancy hospitalization. IV hydration and medication management are prudent tools to use for people who experience such a difficult and dangerous time.
Thank God, most people do not experience HG, but even normal amounts of nausea with or without vomiting can be challenging. This is where I am right now. Hooray. Thankfully, there are tools that can help manage the symptoms. Keeping blood sugar regulated with small frequent meals and maintaining hydration is always the first step. Granted, this is often way easier said than done when food is just gross. When smells are soooo… smelly. And even your own tongue tastes icky. *raises hand* Ugh. But for most people this is temporary. Most people get relief by 10-12 weeks, though some don’t get it till later. So, snacks. Lots of snacks. Different forms of hydration- water, lemon water, NORA tea, other herbal teas, broths, electrolyte drinks, and so on. Just like with the food, hydration if done too overzealously in an episode can set off the nausea, so just constant sipping and snacking. Though it requires some planning ahead and it can definitely get annoying, it is less annoying then feeling like you want to throw up at any given moment. I’ve also gotten nice relief from “morning sickness sweets.” Though for many the nausea is not isolated to the morning, these candies have vitamin B6 and ginger. Both have research supporting their use in reducing nausea. The B6, just like the food any hydration, works best as a slow release, rather than a single large dose. In fact one of the main leading prescriptions for nausea in pregnancy has B6 as one of its two main ingredients.
Lily Nichols, my favorite pregnancy nutrition expert, has some tips she shares here: https://lilynicholsrdn.com/first-trimester-tips-nausea-fatigue/
I was having a conversation with several other experienced moms and we all agreed; first trimester is the hardest. You deal with fatigue, nausea, bloating, and also get to have anxiety about the pregnancy without the reassurance of feeling regular baby movement. You aren’t almost done and about to meet your baby face to face. You don’t have a cute baby bump yet, just a bloat and stretch bump. For many people, they aren’t even telling people yet so they can’t get the commiseration that can sometimes be therapeutic. BUT, you can do it. You will get through this to the next phase, and it is so worth it.
5 weeks
At 5 weeks gestation (~3 weeks after conception) baby is expected to be about 2mm long, or the size of a sesame seed. The neural tube is forming to develop the brain and spinal cord, and the heart begins to beat this week! On ultrasound sometimes the heart beat can be seen at this stage (it looks like just a little pulsing cluster of pixels), though it is more consistently seen after 6 weeks. A fun verse for this stage is Psalm 139:13. KJV- "For thou hast possessed my reins: thou hast covered me in my mother's womb". According to some sources, this translation choice for the original Hebrew words, with "reins" refers to the kidneys or inner being, and "covered" having connotations of both protection and weaving. Another translation in the NASB is "For You created my innermost parts; You wove me in my mother's womb". When you study how the neural tube is formed, it really is much like knitting or weaving, wrapping the inner parts neatly into their correct place. It is wild to me that such a tiny, yet complex structure is a new being, and this new being is already having noticeable effects on the much bigger mom.
This tiny little baby is going through rapid changes and is vulnerable to dangerous environmental exposures. I wanted to share an awesome resource that can be super helpful in navigating our environmental exposures. At this point, I think most of us are aware that there are toxic chemicals in many (most?) everyday products and foods. Especially when you are just learning or have questions on specific ingredients or products, it is helpful to have an unbiased resource. This can help us see through some of the very annoying “green washing.” (Just because a product comes in a matte bag instead of glossy, does that mean it is better?) Enter the Environmental Working Group (EWG) EWG . This is a consumer guide to help people make better, more informed decisions. (Informed decisions are my jam! *chef kiss*) They have a free app too. In today’s modern world it is literally impossible to avoid all toxins. Those of us who get trapped into this obsession of trying to do everything right (and feeling like a failure if not) please take a breath, and realize it is literally- and I do mean literally- impossible. All we can do is try to limit our exposure (especially in pregnancy, and even more so in the first trimester when the developing baby is at the most fragile.) But thankfully, we are built with means of detoxifying many (though admittedly not all) of these exposures. What seems to be a reasonable goal is to try to not overload our systems. An analogy that I like is this: Imagine we all have a cup (our threshold of toxins we can handle) and it is raining. When the cup overflows, we experience negative consequences from toxic overload. It may be better to stand under a tree than under the downspout. (If we were to add a spoon or pipette to periodically syphon off some water to illustrate the detox pathways, that would be a more accurate analogy but also maybe a bit convoluted…)
For those who want more of a handle on an intro to understanding environmental toxins, send me a message and I will share with you a (free) little ebook that can be an excellent start. A tip you can super easily incorporate now is avoid touching receipt paper with your skin, and prevent your kids from touching them too. Specifically thermal receipts found at most point-of-sale transactions, including grocery stores, restaurants, banks (ATMs), gas stations, airports, and movie theaters use heat to activate a chemical reaction that produces the image, rather than ink. They are laden with bisphenol A (BPA) and bisphenol S (BPS). BPA and BPS are linked to cancer and reproductive harm. Holding one for even 10 seconds can cause the skin to absorb enough to exceed the safety threshold. Though some alternatives exist, many are also toxic, and activists are urging companies to use something safe to avoid “playing Whac-a-Mole” with dangerous chemicals. So, choose electronic receipts whenever possible, do not handle receipts more than necessary, wear gloves if you have to handle them regularly, and wash your hands with soap and water (NOT hand sanitizer since this increases absorption.)
In other news, this week I have noticed an increase in fatigue and some nausea. So far it’s not terrible, but paired with the cold I’m dealing with right now, it is a bit exacerbated. Frequent snacking and staying hydrated does help. A snack that really hit the spot this week was hard boiled eggs dipped in soy sauce. Protein and salt- yum! We get a decent number of eggs right now from our backyard chickens, which makes this snack feel more accessible. Chickens who are raised on pasture (like ours) lay eggs that are lower in cholesterol, higher in omega-3, vitamins A, D, and E, and more choline than “conventional” eggs. (I put “conventional” in quotes because when we compare chicken husbandry for most of history, it was only recently we started keeping chickens in tiny enclosures away from sunshine, fresh air, bugs, and natural behavior. The idea of raising chickens to roam is not new, it was the original.)
Nutrition highlight is choline! Choline is in the B vitamin family, and is involved in some of the same pathways as its relative- folate. Both folate (the natural form of folic acid, which is synthetic,) and choline have an important role in the neural tube development. According to more recent research (for references to said research, see the full article linked below), the amount of choline that is needed to optimize placental function (which may help reduce risk of preeclampsia) and improve cognitive development is nearly double current recommendations. According to Lily Nichols, RD,
“Our current recommended intake for pregnancy is set at 450 mg. Many of the supplementation studies have compared choline intakes of 480 mg (slightly above the recommended intake) to 930 mg per day. The women receiving 930 mg/day consistently show improved outcomes, as do their babies.”
Please read this super interesting article on more choline goodness: Choline in Pregnancy: Folate’s Long Lost Cousin - Lily Nichols RDN. One big takeaway is egg yolk is much higher in choline than most other sources. Egg yolks and liver provide generous sources of choline, which getting from plant based food alone would require significantly more food. Another meal that has been a hit for me this week is over-easy eggs with sourdough toast, and a side of roasted veggie soup. It feels comforting as the weather continues to cool, gentle on my slightly more fragile stomach, packs a good nutrition punch, and is quick to put together (since I am reheating the soup that was already made.)
Another breakfast (or all day?) topic that is worth mentioning is caffeine. For me, my aversion to coffee sadly continues, which I have replaced with tea- usually the NORA tea or roasted dandelion tea, sometimes mixed with black tea. But for those who do not develop an aversion to the beloved bean infusion, we should talk about caffeine intake in pregnancy. There is a recommendation to keep caffeine intake below 200mg daily. For reference, a standard 6 oz (yeah- 6 oz is standard… come on, who does 6 oz?) cup of drip coffee is generally 70-120mg, and a cup of tea made from 1 bag of black tea is around 50mg. The reason for this recommendation is that studies have found an increased risk of miscarriage, low birth weight, and growth restriction with consumption greater than 200mg. When the caffeine passes through the placenta, the baby’s ability to process it is slower than for the adult and therefore the effects may be stronger for the little developing body. We also know that caffeine increases constriction to blood vessels, increases blood pressure, and is a diuretic (makes you pee more.) What I suggest to those who find caffeine withdrawal headaches or fatigue too much to deal with, try mixing your normal coffee with ½ decaf, like swiss water method decaf, or consider switching to tea. Don’t get me wrong, there is also data that mild coffee intake can have some health benefits, but maybe aim more for postpartum, or at least after the first trimester, and keep it under 200mg daily.
Thanks for joining me!
Let me know if you have questions for me, or have topics you’d like me to discuss, send me a message and I’ll do my best to address them!
Disclaimer: my choices are mine and are in no way medical advice. You should always speak to your trained and trusted maternity provider if you have questions or while developing your own plan. This series is for story telling purposes and reflects the decisions I’ve made considering my history, personal preferences, and philosophy.
4 weeks
Disclaimer: my choices are mine and are in no way medical advice. You should always speak to your trained and trusted maternity provider if you have questions or while developing your own plan. This series is for story telling purposes and reflects the decisions I’ve made considering my history, personal preferences, and philosophy.
This series is going to be extremely personal. I’m inviting you to walk along with me for this pregnancy. I’ll share portions of my journey, as a midwife and mother going through my fifth pregnancy. (I am already blessed to have three beautiful children earthside.) I feel called to manage my pregnancy myself, though I plan to use another sister midwife for birth care. Labor and birth is not a time I want to have my clinical hat on. It’s best for me to just be purely primal/ instinctual at that time. At times I’ll share with you my decision making process, my plans, and sometimes just share personal stories. So, here we go!
4 (ish) weeks: I’d been tracking my cycle with fluctuating amounts of detail for several cycles. I knew I wanted to have another baby within the next year, and observing your cycle can give you fascinating insights to your overall health. (I highly recommend the book The Fifth Vital Sign to learn about this.) Historically I don’t have many periods between pregnancies since my cycle is kept dormant for a while as I nurse into toddlerhood. (And I do still nurse my two year old! More on breastfeeding through pregnancy later.) I really wanted to use the opportunity to see what my cycle did while it fit my desires for our family. One trend I saw for a few cycles was an indication of low progesterone (spotting in luteal phase among others) which was supported by bloodwork.
Super brief review/intro to the phases of the menstrual cycle. The first day of the period is considered day one of the cycle, starting with the menstrual phase. This is followed by the follicular phase where the follicles in the ovaries are maturing and an egg is getting ready to be released while the uterine lining is building. In the couple days before ovulation, cervical mucus is produced which can help sperm stay alive and nourished in the body till the big moment when the egg is released. Next comes ovulation, usually midcycle, when an egg is released from a mature follicle. The egg is only around for 12-24 hours and therefore cervical mucus quality helps sustain a fertile window before ovulation and then for as long as the egg is around. When the egg is released, the follicle that released the egg also in effect makes the corpus luteum, the temporary structure created with ovulation that produces progesterone in the luteal phase and in early pregnancy. The corpus luteum helps preserve the endometrium lining for the luteal phase until either hormonal changes from the pregnancy sustain the endometrial lining for the first few weeks of pregnancy or, if pregnancy was not achieved, the endometrium sheds and we begin a new cycle with the return of the menstrual phase.
https://cdn.britannica.com/07/55707-050-5927EDFB/changes-woman-cycle.jpg
I started taking vitex/chasteberry in the luteal phase to help support the corpus luteum. Symptoms of low progesterone declined, yay! Since I suspected we were successful this cycle, I tested day 24 and 25 of my cycle. I wasn’t sure if the first test was faintly positive since the testing conditions were less than ideal- a mid day void in a freezing outhouse on our rustic vacation- but day 25 test was clearly positive! As I think back, I had noticed much more vivid dreams for about a week beforehand too. It was so fun that the clear positive was on my husband’s birthday!
I shared the news immediately with my husband, and 7 year old daughter. I decided years ago, with my first pregnancy, which was also my miscarriage, that I would share the news of my blessing as early as I wanted, even though I understand all too well there is the highest probability of loss in the first 8-12 weeks. I personally want to share my joy, even if I don’t get to meet the baby earthside. I love my baby from the absolute beginning, and for me, one of the ways I express that is by sharing the news. So, I chose to share early.
Other than vivid dreams, the only other symptoms I’ve noticed this week are bloating (glamorous) and occasionally having a hard time drinking my normal morning coffee. I am not a heavy coffee drinker and usually have a ½ caf coffee each morning with collagen, so not being able to finish my routine mug isn’t too great a loss.
This was a planned pregnancy, and I am feeling blessed and delighted… while also managing some normal concerns. Obviously I’m older than I have been, (that’s the thing, right, we keep getting older if we are doing it right) and this is my first pregnancy that is considered “advanced maternal age.” Advanced maternal age is defined as a pregnancy that the due date is after the 35th birthday. I will be 36 by then. I won’t speak about this too much (this time- just wait!) but Evidence Based Birth has a great article on this topic that I encourage all who are interested to read. https://evidencebasedbirth.com/advanced-maternal-age/ Abridged version is that I am not overly concerned at this point as the data is not as dramatic as it is often made out to be and I have several protective factors, like having already had babies before. I am due in July, within a week of my current youngest turning 3! I didn’t love being at the end of my pregnancy when it was hot and said I wouldn’t do it again. God laughed at that presumption of mine! Thankfully I have learned some adaptive strategies.
Story time: I was about 37 weeks pregnant and in the third trimester for the first time in the summer heat, since my other two were winter babies. I was grumpy, felt large, hot, sweaty, and uncomfortable. We do not have air conditioners at home but fans. Friends, fans did not cut it that week. I went to lay as naked as possible alone in my room in the late afternoon. My blessed husband took a pair of my fuzzy socks, got them squeezed out wet and put them in the freezer for a few minutes. Then, without saying a word to me, gently placed them on my feet. Ladies and gentlemen, this is real romance. This is why I keep having babies with this man. Core. Memory. Bless him. Husbands, take note.
The heat of the summer isn’t the only thing on my mind that requires some processing on my end. I’m finally in a somewhat regular workout routine and hoping to continue throughout the pregnancy, though realizing my jujitsu likely needs to be adapted significantly if I’m to continue for a while. Thankfully it is both recommended and encouraged to stay active in pregnancy. As always, listen to your body and talk to your trusted provider (see disclaimer.) In general, staying physically active in pregnancy helps SO much, with just about every aspect. Currently, I am weight lifting, running, and doing jujitsu. Likely all will need modification as the pregnancy progresses but I can take that as it comes. Since I’m so early in the pregnancy, and still feeling good, the general plan is to continue as normal for now. I also am going to dedicate more time specifically on core and pelvic floor support. This is not my first time, and the body remembers what it is like to be pregnant. It is almost like the more experience you have, the more readily the body shifts into pregnant mode. One of the reasons I, and many other experienced mothers, look more pregnant sooner.
I’m also wrapping my brain around preparing my practice for maternity leave, now that I’m a solo practitioner. Not-so-fun fact, the USA is one of TWO countries in the entire world that does not have guaranteed paid maternity leave. Everywhere else does. Let that sink in for a hot minute. Gross. No wonder our national statistics are horrendous comparatively to similarly industrialized nations. (I’ll probably rant more about that later…) In 2022 Connecticut, where I live, finally passed the CT Paid Family Leave, which gives most people the ability to be on parental leave from work at about 60% pay for 12 weeks. With the structure of my practice I do not have access to that this time. I have no desire to be competing with my clients about who is going to go into labor first. With other pregnancies I have worked until close to birth, and really didn’t love it. I like being able to have a few weeks to mentally and physically prepare. I’ve decided I’m going to stop taking clients who are due June and beyond till I’m ready to ease back in in the Fall of 2026. This also means I need to be careful about specific financial planning.
So this time, one of the things I’m trying to focus on is nutrition. Especially since food still feels reasonably normal at this point. Enough protein (140+ grams daily) veggies and fruit, minimal processed foods, fish, eggs, dairy, and hydration. NORA (nettles, oat straw, raspberry leaf, alfalfa) tea, liver capsules, probiotics, cod liver oil, magnesium, and maintenance dose of Vitex are all things I’m incorporating at this point. I know some feel raspberry leaf tea is not appropriate for the first trimester, and I don’t think there's anything wrong with avoiding it during this time. However there seems to be a misunderstanding about what red raspberry leaf tea (RRLT) does. It has traditionally been used as a uterine tonic, not specifically to cause contractions. Will a toned uterus at term contract-yes, ideally! That does not mean, though, that it will cause premature contractions. To the best of my knowledge the scientific research that does exist on RRLT shows no indication it causes uterine contractions. Its main job here is to strengthen and tone the uterus. NORA tea is full of minerals, helps prevent and reverse anemia, source of vitamins, chlorophyll, can help prevent and treat varicosities (like hemorrhoids and varicose veins.)
The kids (7yo and 4yo) are very excited and we are using this opportunity to learn about the stages of development of babies in utero in some of our homeschool lessons. They think it’s adorable that the baby is about the size of a chia seed at this point. My 7 year old was around for, and clearly remembers the birth of the third, who was our first born at home. Some of my favorite pictures of that labor were of my then 5yo daughter and 7yo niece being part of my support team. It was so beautiful to share it with them. Yes, there were plenty of adults too. It was a real birthday party! I am a social birther, I guess. More on support team, including kids in later posts.
1 Samuel 1:27 For this child I prayed; and the Lord hath given me my petition which I asked of him:
Thanks for joining me!
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