Pregnancy

There is an overwhelming amount of information out there regarding pregnancy, what you “must know” and what is safe/unsafe. Here are some resources and information that is midwife tested and might come in handy during your pregnancy.

I’ve created a few Amazon lists of books and items that might be helpful in pregnancy. I have no affiliation with any of the items on the lists.

Anemia

http://www.hematology.org/Patients/Anemia/Pregnancy.aspx

Breech Position
https://spinningbabies.com/learn-more/baby-positions/breech/flip-a-breech/

Childbirth Education

Penny Simkin is amazing for anyone, has also focused on women with a history of trauma in her later years

Birth Boot Camp offers online childbirth classes

Miri Levi- Miri is a Family Nurse Practitioner, Nurse-Midwife and Lactation Consultant here in Anacortes and offers a variety of classes

Island Hospital offers 2 day and 6 week childbirth classes

Depression & Anxiety

See Postpartum Depression & Anxiety

Drug and Alcohol Use

The links below lead to an organization that offers information, resources and treatment for addiction. While I have no affiliation or endorsement of the organization, their pregnancy information page is solid:

Gestational Diabetes (GDM) & Testing

This is a complication of pregnancy that occurs in 4-9% of pregnancies (depending on who you ask and when) and you cannot tell who will get it based on appearance or history. This is routinely tested for between 16-20 weeks (if high risk: Hispanic, Native American, East Indian, PCOS, BMI>30, prior GDM diagnosis and/or family history) and 26-28 weeks (only at this stage, if low risk). There is more than one way to screen for diabetes. There is a one-step or a two-step approach: 

  • For the one-step, you will need to make an appointment with lab.  You will come in fasting.  They will draw your blood.  You’ll drink a beverage with a measured amount of glucose.  Then, they will draw your blood at 1 and 2 hours after drinking the beverage. If all of these numbers fall within normal, you do not have gestational diabetes.  If one of the numbers falls higher than the normal, you are diagnosed with gestational diabetes and we will begin diabetes management. 

  • With the two-step approach, I will give you the glucose drink at an appointment.  Do not eat or drink anything after you drink the glucose.  The goal of this test is for the lab to be drawing your blood 1 hour after you drink the glucose. The lab will only be drawing your blood once.  If this level is high, I will order a second test to determine if you have diabetes.  The second test is the 3 hour test.  It is similar to the 1 phase approach except you have an extra blood draw at the 3 hour mark.  If 2 or more of these values are abnormal, you are diagnosed with diabetes and referred for diabetic management. 

  • If you are strongly opposed to these testing methods or the glucose drink, there are alternatives that we can discuss during your appointment.

These are the guidelines I go by for diagnosis and management of gestational diabetes: https://www.cdappsweetsuccess.org/Portals/0/2015Guidelines/4_MedicalManagement&EducationForGDM.pdf

Medication

The majority of medications lack evidence of safety in pregnancy. Studies to establish medication safety in pregnancy have difficulty recruiting test patients (go figure) and are generally not considered ethical to perform. That said, many medications are considered to be safe and may be used in pregnancy. For a list of safe medications that may be useful, if needed, during your pregnancy see my Amazon list.  I have no brand affiliation and you may absolutely choose a different brand of the same medication. If you have questions about something not on this list, please call.

Nutrition, exercise and weight gain

This can be a huge source of anxiety during pregnancy. ACNM has a series of helpful handouts available to view or download. The series ranges from basic nutrition to specific vitamin intake recommendations. Just remember that you’re nourishing not just yourself, but your baby during your pregnancy. And do exercise. It will help ease aches and pains later in pregnancy, as well as prepare your body for labor and recovery. I don’t mean drenched in sweat, miserable on a treadmill. Walk, bike, swim and make the people around you do it with you. Make it a habit and make it enjoyable.

https://www.nutrition.gov/subject/life-stages/women

http://americanpregnancy.org/pregnancy-health/pregnancy-nutrition/

Posterior Position

Don’t stress yourself out. 90% of babies who start out in an OP or “sunny-side up” position, rotate to a more favorable position during labor. However, if this is worrying you, here’s a resource with things to try:
https://spinningbabies.com/learn-more/baby-positions/posterior/

Smoking

Don’t start smoking during pregnancy and if you do, stop. Smoking is directly associated with growth restriction and placental insufficiency during pregnancy, as well as pre-term labor and abruption (the placenta coming away from the uterus and is an emergency). If you are a smoker and you can stop smoking by 16 weeks of pregnancy, the risks of smoking can be minimized for your pregnancy.

Travel

In a healthy pregnancy, travel is perfectly safe up until 36 weeks. The only reason that the travel is limited at 36 weeks is because of the increased risk of contractions and labor which could constitute a “medical emergency” for the airline.   You are also not going to be the most comfortable traveler after 36 weeks, so I would reconsider long car trips. The only real danger of travel in pregnancy involves the increased risk of blood clot due to inactivity. People run the risk of getting a blood clot when still for too long, pregnant or not. When pregnant, that risk increases. You can reduce this risk by making sure you drink plenty of water and stretching your legs or walking frequently. The bladder tends to be a helpful reminder to get up and move, as pregnant women can’t go long without going to the bathroom anyway. There are no real studies for this, but I sometimes recommend a single adult aspirin before a long trip. There is no harm in a single dose and the effects on making your platelets “less sticky” lasts for 10 days. I would be happy to proved a travel letter, if requested, for travel before 36 weeks of pregnancy.

Zika virus is still out there. Please discuss this with me if you or your partner traveled to a Zika risk area within 6 months prior to conception or if you are planning to travel to a Zika risk area during pregnancy. If you can change your plans and go to Hawaii, I highly recommend it.

https://www.cdc.gov/zika/geo/index.html

Zika Map

Vaccines

Both the Tdap (between 27-36wks) and influenza (any time) vaccines are recommended in pregnancy by every organization who has any kind of authority to say so (CDC, ACOG, ACNM, AAP, etc.). A great deal of research has proven that it is not only safe, but effective. By receiving these two vaccines, you protect yourself, your pregnancy and your baby after they are born. It’s like you’re taking a hit for the team. Way to go mom! That said, if you don’t want them, don’t get them.
https://www.cdc.gov/vaccines/pregnancy/hcp/guidelines.html

WA 2-1-1

North Sound 2-1-1 is a resource for human service programs in the area

Location: Everett
Hours of Operation:M-F, 8am-5pm Toll-Free: (800) 223-8145
Website: https://www.voaww.org/behavioralhealth
Counties Served: Island, San Juan, Skagit, Snohomish, and Whatcom Counties

WIC

Women, Infant and Children Food and Nutrition Program serves families and helps children get a healthy start. Pregnant women, breastfeeding women, infants and children up to age 5 are encouraged to apply.

Main office in Mount Vernon: 330 Pacific Place / Ph# (360) 416-7595 / Monday-Thursday 8:30am-6:30pm, Friday 8:30am-5pm

Anacortes Office: 2601 M Ave, Suite C (behind Island Hospital) / Ph# (360) 416-7595 / Tuesdays 9am-5pm

wic_info@communityactionskagit.org
https://www.doh.wa.gov/YouandYourFamily/WIC

Birth

Childbirth Education

Penny Simkin is amazing for anyone, has also focused on women with a history of trauma in her later years

Birth Boot Camp offers online childbirth classes

Island Hospital offers 2 day and 6 week childbirth classes

Multiple birth topics

https://evidencebasedbirth.com/blog/

Perineal tearing
https://www.cochrane.org/CD006672/PREG_perineal-techniques-during-second-stage-labour-reducing-perineal-trauma

Postpartum

Depression & Anxiety

An online testing tool for depression and anxiety. You can do this on your own and the site will calculate your score and let you know basic recommendations. I recommend you discuss the results with your care provider. http://perinatology.com/calculators/Edinburgh%20Depression%20Scale.htm

This form can help you to identify symptoms and start a conversation with your provider: https://postpartumprogress.com/download/new-mom-mental-health-chec ***Additional languages are available on the website.

A comprehensive website from our Washington chapter of Postpartum Support International. You will find information, counselors and area support groups here: www.ppmdsupport.com

A blog with lots of information, including books you may find helpful: www.postpartumprogress.com

Another blog with lots of information and resources: https://womensmentalhealth.org/resource/patient-support-services/

General information about therapy/counseling: https://onlinelibrary.wiley.com/doi/epdf/10.1111/jmwh.12683

Warm Line- There is also a toll-free peer support line 1-888-404-7763. Leave a message, and a trained volunteer will return your call within twenty-four hours.

Weekly online support meetings: http://www.postpartum.net/get-help/psi-online-support-meetings/

Help for military families, also with an online support group: http://www.postpartum.net/get-help/psi-support-for-military-families/

Swedish has a fantastic Day Program for treatment: https://www.swedish.org/services/day-program-for-women-and-newborns

For Dads: www.postpartumdads.org and www.postpartummen.com ***NEW!  Dads line- call the Warm Line at 1-888-404-7763 and ask to talk with a dad.  Dads can talk to another dad about their own mental health needs during this period as well as gather information about supporting a partner who might be experiencing their own mood or anxiety disorder.

Breastfeeding

International Breastfeeding Center Information Sheets

https://ibconline.ca/information-sheets/

Kelly Mom

https://kellymom.com/

Loss & Grief

MISS Foundation- A community of compassion and hope for grieving families

Books & Podcasts

Amazon Reading List

Information about everything to do with women, by 2 female OBGyns: The V Word podcast

Evidence Based Birth podcast

A doula led discussion with interesting guest speakers about everything birth related: Birthful podcast