Movement for Every Trimester: Adapting Your Routine as Your Body Changes

There have been so many fitness trends in my longish life. It’s hard to know what to believe sometimes. And when you’re thinking about pregnancy fitness, there are trends, but it also feels like a more high stakes situation that you probably want to get right. So what is the right thing to do?

In almost every pregnancy, there is general agreement that movement is good for you. Exercise can help you have a healthier pregnancy and feel better while you do. It’s a lot harder to figure out what type of exercise to do and how much is healthy. And there are different considerations depending on whether you’re already an athlete or are just starting to get into exercise.

A Brief History

A few decades ago and even more recently in the United States and in other cultures, pregnant women were treated with a lot of delicacy. It was thought that she should rest a lot and be taken care of. Manual labor might have been prohibited and exercise just wasn’t a thing. But a healthy pregnancy might have also included alcohol and cigarettes, so they may not have been getting everything right! I have a friend from eastern Europe who was horrified to see me using a tile saw during my first pregnancy. He was raised to believe that using electric and power tools was dangerous during pregnancy, so they were even discouraged from using appliances like a vacuum. Our children and future grandchildren are very lucky that we have learned more about how to be healthy during pregnancy.

But if you go back even further to biblical times, scholars were observing that women who were more active during pregnancy, such as people from the slave and servant classes, had easier deliveries. Those kinds of observations even led Aristotle to recommend exercise to ancient Greek aristocrats!

Benefits of Exercise

Besides being fun or the fact that it can make people feel better while they’re pregnant, research shows that a healthy amount of exercise can offer the following benefits:

• Decreased risk for high blood pressure and preeclampsia
• Decreased risk for gestational diabetes
• Better sleep. It can be hard to sleep well when pregnant, but when your body is strong and flexible, some of the pregnancy discomforts that might keep you awake will be gone. Good sleep during pregnancy lowers your risk for postpartum depression.
• Exercise during pregnancy also more directly lowers your risk for postpartum depression.
• As long as you are having an uncomplicated pregnancy, exercise can actually lower your risk for preterm birth.
• There may be a link to improved brain development for babies.
• Increased energy levels
• Improved mood
• Increases your chances for a complication free birth
• Exercising during pregnancy can help you maintain healthy levels of weight gain which can also assist in helping you return to or maintain a healthy weight after you give birth.
• Exercise in pregnancy can help you have a quicker and less complicated physical recovery postpartum, lowering your risks for pelvic floor disorders and diastasis recti.

How to do it

I interviewed Stacey Rikalo of femSTRONG for help with this article. She has been working as a fitness and strength trainer, specializing in the perinatal period. That means she works with folks who are pregnant or returning to exercise following birth. Based on her work, she knows that women can do a lot during pregnancy. They can maintain most of their routines and maintain a pretty high level of fitness. She usually works with athletes. These are people who were already doing a lot before becoming pregnant. They know a lot about fitness, what their bodies can handle, and are working with a trainer or coach to help them continue safely. Not everyone has that benefit. I highly recommend watching the recorded interview with Stacey below for a lot more detail, but here are some key takeaways that apply to most everyone:

• FIRST, talk to your health care provider. While it’s true that in general exercise is healthy and safe, there could be some risk factors that make it unsafe. Talk to your care provider about exercise to make sure you don’t have any risk factors that mean you need to be more careful.
• Walking counts! Walking is great exercise no matter your fitness level and is a safe entry level exercise for most everyone.
• Housework/yardwork count too! If you do a lot of physical activity for your job, or you’ve spent the day at home cleaning or doing yardwork and then don’t feel like doing exercise, DON’T! You already did. Exercise doesn’t have to be an organized routine. Moving your body while you clean or do home improvement projects is healthy and counts as exercise. Of course doing more is OK too, if you feel like it.
• Your aerobic and anaerobic capacity diminishes during pregnancy. This basically means that things that used to feel easy or manageable now feel more difficult. Maybe you used to be able to climb the stairs without feeling winded, but now you can’t. This is a normal part of being pregnant. So many of your energy resources are going to growing your baby and your placenta. You just don’t have as much fuel. It’s very reasonable not to push yourself to do the same amount you did before.
• You are TOO flexible. You have a hormone in your body during pregnancy that softens and loosens your connective tissues. That means you have a bigger range of motion in your joints. This is great for allowing your pelvis to shift and widen to accommodate your baby during pregnancy and for birth, but it also means that it’s easier to overdo it in other parts of your body too. When you’re stretching, try not to do the maximum that your joints are capable of. Stay a little below the edge so you don’t cause injury.
• You are less coordinated. This is not a judgment of you, and it’s not your fault. Your uterus is stretching to fit a larger and larger baby, so it has to expand forward and up out of its usual spot in your pelvis to fill your abdomen and then stick out in front! This means that your center of gravity changes dramatically. This is why most people do report feeling a lot more “clumsy” during pregnancy. This also means that you should be extra careful when exercising. For your safety, it might not be a good idea to do things that require a lot of coordination. For example, rock climbing without a pregnancy harness might not be an ideal choice.
• Body temperature is harder to regulate. Pregnancy causes a lot of strange physical changes, and one of them is a decreased ability to regulate your body temperature. This is especially useful information for my local area in Texas! It gets very hot here, and when you’re pregnant, it’s easier to overheat. Consider limiting the amount of time you spend outside in the heat, or do your workouts inside.
• Can you control your movements? If you can walk, run, lift, swim, etc. smoothly and with control, you’re probably doing ok. If your movements feel more choppy, forced, or out of control, you can consider backing off a little.
• Are you feeling heaviness “down there”? It can be a hard thing to understand until you feel it. Some people describe a feeling of fullness in the vagina. It might feel like swelling or bulging. However you describe it, you’ll probably be able to recognize it when you feel it….especially if you’re looking for it. This is the feeling of your pelvic floor organs being squished downward because of some pressure from your movement and probably because of the extra weight from the baby and the laxity in your connective tissues. So, pay attention when you’re exercising. If you notice that a particular movement causes this feeling of heaviness, you might consider doing less.
• Breathing well helps. Stacey talks a lot about breathing as a tool for helping you exercise safely. Your breathing muscle (diaphragm) can be useful for protecting your pelvic floor from injury. Breathing well itself can be a restorative and healthy movement that can also help prevent injury.

First Trimester

For safety, most types of exercise are fine! You don’t have too much going on yet related to your size or progress in pregnancy that can limit your mobility. However, you might not FEEL like doing much. Most people feel very tired and might have a lot of nausea and vomiting. These symptoms can definitely make it harder to exercise. That’s OK! I think you should give yourself permission to lie down if that’s what you need. Sleep if that’s what your body is asking for. Take it easy. Your reserves are being used right now. Your body is deciding what to do about the “invader” that has taken hold. It’s asking you to save your energy to fight off a potential threat OR save it up to give your baby the best start. If you feel up to it, you probably have the most freedom to do what you want for exercise during the first trimester. Move however you can, and remember that some gentle exercise might actually help you feel better.

Second Trimester

Most people feel better during the second trimester. I want to recognize that this is NOT true for everybody. Most people though are feeling less tired, more hungry, and starting to get that “pregnancy glow” that people talk about. You’re starting to see a bigger, rounder belly, and hormones are stabilizing a little. You’ll likely still have other symptoms that come up during the second trimester like heartburn or constipation or hip pain, but they just might not be the sorts of symptoms that make exercise impossible. So, you might start to feel more ready to exercise, AND THEN you might notice that it doesn’t feel the same or you have to modify things. That is normal. It’s a good idea to listen to your body when you notice these differences. Do less when you need to. Pay attention to the “HOW TO DO IT” section above. The second trimester is the point in pregnancy where it might be most important to follow some basic guidelines so you don’t overdo it. On top of all of the other things already covered, your abdominal muscles will begin to separate, and you want to make sure you’re guarding that area. That might mean changing the way you are doing core strengthening. Stacey loves to recommend “carries” during the second trimester.

I also want to recognize that many athletes out there aren’t so good at “listening to their bodies”. This is NOT a criticism! It just means that intense training often involves pushing past a threshold. Athletes have to work harder, push themselves, feel the burn. Most of the time, this is a great way to get stronger, but in pregnancy, your body might actually be trying to give you warning signs. If you are an athlete, try not to ignore those signals, or give yourself some great boundaries to stay within for safety.

Third Trimester

When you reach your third trimester, you might still be feeling great, but eventually most people start to feel more heavy and less energetic. A lot of people feel like winding down some and conserving energy in preparation for birth and early parenting. You might also be having some new pregnancy symptoms that make things harder. You are carrying a lot of extra weight. Your baby might weigh 4-7 pounds, your placenta probably weighs 1-2 pounds, you’re carrying about 2 pounds of amniotic fluid, a pound of extra breast tissue, 3 lbs of additional blood, a couple of extra pounds of uterine muscle, about 4 lbs of extra water, and about 8lbs of maternal fat stores. That basic gain alone is 20-30 extra pounds! For the fitness fanatics reading this, imagine carrying around a weight that size at all times. You are using energy that you weren’t using before.

You may also need to do more modification in your exercise related to the size of your belly. It’s pretty large in the third trimester, and can definitely be an obstacle to some of the things you might be used to doing. You also might be feeling more heaviness in the pelvis during the third trimester which is a good indication that you should do less.

Pelvic floor strengthening is recommended for many people, especially in the first and second trimesters, but the third trimester is a good time to focus on learning how to relax and soften in the pelvic floor.

I am most definitely not a fitness expert. In my own pregnancies I walked and did prenatal yoga. I can definitely recommend that program, although it’s definitely not the perfect program for everyone! Besides the morning sickness, I felt pretty good. I was strong and had a fair amount of energy. I did learn that my pelvic floor needed some guarding though! I had some injury to my pelvic floor after my second birth. I saw a pelvic floor physical therapist for help, but I sometimes wonder if I might have prevented some of the injury by seeking that help during pregnancy. Seeing a pelvic floor physical therapist is a great idea for anyone who wants to work on pelvic floor strengthening, control, AND softening. It’s also a good idea to talk to your pelvic floor physical therapist about your exercise program. They can help you ensure safety for your pelvic floor while getting the most from your workouts.

I was very happy to have guidance from Stacey in writing this article. Please watch the video to see more and find out about some of Stacey’s favorite resources related to exercise during pregnancy. You can also look for two more follow up articles and recordings discussing exercise AFTER birth!

References:

Physical Activity During Pregnancy – Past and Present – PMC

Breaking boundaries: A chronology with future directions of women in exercise physiology research, centred on pregnancy – ScienceDirect

A comparison of beliefs about exercise during pregnancy between Chinese and Australian pregnant women – PMC

Antenatal taboos among Chinese women in Hong Kong – ScienceDirect

If you are or have ever been pregnant, you probably know exactly what pregnancy brain is. But if you try to describe it to someone who has never heard of it, you might not be able to! It is actually a common pregnancy side effect that is poorly understood.

What Pregnancy Brain Feels Like

A lot of people don’t recognize that they feel different. Other people notice big changes. You might notice some or ALL of the following:

• Forgetfulness
• Loss of focus
• Trouble concentrating
• Clumsiness
• Slow thinking or response time
• Brain fog

Sometimes it’s really hard to describe. Some people report that they just don’t feel like themselves. Things might feel harder, or time might feel like it’s moving more slowly or quickly.

What Pregnancy Brain Looks Like

Even when you might not notice anything different, other people around you might! I remember being pregnant for the first time and realizing that my job had gotten a lot easier. It seemed like there just wasn’t much work to do anymore. Later, my boss told me that she just kept the work away from me, because I was making so many mistakes! I didn’t realize I was making those mistakes, but that was a little bit of a wake-up call for me, and I started to notice some of the other changes. I was definitely more clumsy, and just had a harder time keeping my thoughts organized. I’ve heard plenty of stories about people doing strange things during pregnancy. Some of my favorites:

• Finding their phone in the refrigerator
• Leaving the car running in the driveway all night
• Putting multiple cribs on the baby registry
• Forgetting their own baby shower!

How the Brain Changes

This is going to sound a little bit scary, but there is an actual physical reason for pregnancy brain. Saying “it’s hormonal” is an oversimplification and an understatement. That is definitely happening, but there’s more.

Researchers have been studying the pregnant brain using MRI scans. They have discovered some very interesting changes.

• The actual volume of the brain decreases significantly. You actually have less gray matter during pregnancy! So you can literally say that you have less brain. That’s the part that sounds a little scary, and also like it might account for the pregnancy brain symptoms.
• There is an increase in white matter throughout the brain during pregnancy. White matter increases are also observed when someone is developing a new skill such as learning an instrument. I like to think that the brain is restructuring during pregnancy to help us be great parents!
• There is also an increase in the volumes of cerebrospinal fluid in the C-shaped cavities called lateral ventricles in the brain.
• Some of these changes are at least partly permanent, while others go back to baseline after pregnancy.

The Role of Hormones in Pregnancy Brain

It does seem like hormones are the trigger for these brain changes. Your steroid hormone levels, including estrogen and progesterone can increase by 100 to 1,000 percent during pregnancy. These big hormonal increases definitely seem to be what cause the changes in the brain. So in that way, pregnancy brain is hormonal. But it’s more than that. The hormonal changes can have a big impact on the way you feel and how you operate, but add the actual change in brain volume to that, and you get pregnancy brain.

Managing Pregnancy Brain

Here are some tips to help you manage pregnancy brain:

• Use recurring phone alarms. Did you know you can probably even speak the command into your phone? “Set a daily alarm to take my vitamins at 8am.”
• Do double checks. For example, before you leave the house, have a checklist. Did you do everything? Do you have everything?
  • Turn off lights
  • Turn off stove
  • Phone
  • Keys
  • Shopping list
  • Etc.
• Pack separate bags for things and keep them near your door or wherever you keep your keys. If you’re going to the gym, take your gym bag. If you’re going to work, take your work bag. It can be pre-packed with everything you need for that activity so you don’t forget something as you’re rushing out the door. 
• Ask someone else to double check things for you, especially at work! You might have a sympathetic co-worker who can read over your emails before you send them, or double check your work before you finalize things. 
• Give yourself extra space. Recognize that your spatial awareness and judgment might be a little off.  To avoid bumping into people and things, you might just exaggerate the space you give. 
• Set up routines or do some “coupling”. To avoid forgetting things, try adding things into your already well-established routines (the things you never forget). For example, start keeping a glass for water next to your toothbrush. Every time you brush your teeth, this can remind you to drink a glass of water. You have “coupled” teeth brushing with water drinking. Maybe you can couple your pelvic floor physical therapy with watching your favorite show. 

What Does This Mean For YOU?

The restructuring of your brain during pregnancy happens in a certain order. Certain things happen in the second trimester, others in the third. I like to think this means that you get time to adapt, so you might even be thinking more clearly at the end of pregnancy. Science has been able to see WHAT is happening in there, but they can only guess at WHY. I think it’s fun to make up those reasons for ourselves now. I like to think that these brain changes are providing us with necessary coping mechanisms. Our brains have to reorganize and restructure to help us deal with what’s happening in our bodies, and also to help us prepare to care for a small vulnerable baby. It’s a brain workout in preparation for parenthood.

I think it’s also great to remember that pregnancy is a big deal. Your body is doing some very amazing and challenging things, even while you’re just sitting or sleeping. I think this means that you should take it easy on yourself. It’s ok to do a little less of the things you were doing before. If you’re making a lot of mistakes at work like I did, ask about lightening your workload a little or finding things to do that are less critical or delicate. Don’t beat yourself up when you make mistakes, forget things, or lose something. This is just part of the deal when you’re growing a baby. Your body is strong and wise and knows what it’s doing. You might even embrace it and write down the bloopers so you can laugh about it later.

References:

Brain changes observed during pregnancy | National Institutes of Health (NIH)

Neuroanatomical changes observed over the course of a human pregnancy – PMC

Change in the Brain’s White Matter: The role of the brain’s white matter in active learning and memory may be underestimated – PMC

So many things change during pregnancy. You will likely notice changes in your skin, hair, breasts, and of course the belly. Something you might not hear much about is the changes you might experience in your vagina and surrounding areas during pregnancy. There is some really interesting research happening in the area of the body’s microbiome especially related to pregnancy and birth as well.

It might look different

Very early in pregnancy, you might not be able to see dramatic changes in the vagina, vulva, or labia. You might notice some slight enlargement or discoloration. Your blood supply is increasing, and this is normal. You may see more veins, and the color of your skin might look darker, or even look blue or purple! That’s ok too.

You may also notice increased discharge which is usually milky-looking and mostly thin and watery. It should not have a foul smell, be colorful, or be thick or chunky. If your discharge smells bad, or looks abnormal, talk to your care provider. Increased discharge is normal during pregnancy and is your body’s way of minimizing your risk for infections. That extra fluid can capture and remove unhealthy bacteria, keeping it from building up around the womb and causing a problem.

You may even have some bleeding. This is not all that unusual during the first trimester. It can be implantation bleeding which happens when the fertilized egg attaches to the lining of the uterus. You might also bleed a little right after vigorous exercise, an internal exam or sex. Your cervix may be a little more sensitive during pregnancy because of the increased blood flow.

Because bleeding can also be caused by miscarriage or other things, it’s best to get in touch with your care provider. Make sure you only use menstrual pads for any kind of bleeding related to pregnancy and birth. You should avoid inserting anything vaginally for bleeding.

It might feel different

Even in early pregnancy, you might notice some changes in the way things feel down there. You might feel swollen, bulgy, or enlarged. You might even feel a little tingly… in a good way. Increased blood flow to the area can sometimes lead to sexual arousal, and that is totally normal.

It would not be normal to feel a lot of itchiness or pain. That might be caused by an infection, and you should get that checked out, especially if you’re also having some abnormal discharge.

Your microbiome

Everyone has many microbiomes on their bodies. These are areas of specific colonization of microbes including bacteria, viruses, fungi, and others that are designed to help our bodies function in some way. We have a very powerful microbiome in our digestive system that helps us break down and use food for nutrition. We have a skin microbiome, a microbiome in our mouths, and among others, a very special microbiome in the vagina.

The vaginal microbiome is important because this is an area of our bodies that is very open. The vagina opens into the uterus and we have a lot of exposed mucous membranes that can be more vulnerable to infection. Fortunately, you have a very special set of microbes down there that help protect all your parts and your baby while they’re in the uterus.

There is some very interesting new research being done related to the vaginal microbiome. There is an understanding that it’s best to preserve its natural state whenever possible because it is usually a self-regulating system. They are also finding that it changes during pregnancy, and that certain types of microbiome colonization are more associated with preterm or premature birth. The research is still in the beginning stages, but might point to the idea that optimizing your microbiome might be helpful. The ways to do this are not yet proven or definitive, but some of the ideas you might consider include:

• Avoid using douches. They are not shown to be helpful in treating or preventing infections and can actually interfere with your natural healthy microbiome, making you more vulnerable to infections.
• Good hygiene practices. If you can avoid inserting anything vaginally, that’s best. Sex is not necessarily harmful, but it’s best that only clean body parts touch the vaginal area.
• Probiotics might be helpful. Maintaining a healthy microbiome is the best way to go. That can help prevent infections. Probiotics can help with that, and there is even some research that they can be used as treatment for active infections either alone or in combination with certain antibiotics. Using antibiotics is not necessarily bad, but it’s best to use ones that are targeted to avoid wiping out the healthy microbiome. Probiotics can be helpful in rebuilding the microbiome after antibiotic use as well. Probiotics might be taken as a supplement, applied to the vagina externally, or you can eat foods that are probiotic such as sauerkraut, kimchi, or other fermented vegetables, yogurt, and kombucha.
• Wear cotton or other natural fiber underwear. These are breathable and won’t trap all the moisture in creating an environment where harmful bacteria can flourish. Avoiding very tight pants might help too.
• Avoid using harsh soaps or products that use synthetic perfumes, dyes, or chemicals. That would include laundry detergent and fabric softeners. If you notice a bad smell down there, it’s best not to try and cover it up with something perfumey. It’s best to take good care of your natural defenses in the microbiome so your body can take care of the problem. Of course if you suspect that you have a worsening infection, it’s best to contact your care provider.
• General good health and nutrition. Eating a well-balanced diet of whole foods and limited sugar intake may help you maintain a healthy vaginal microbiome. Getting some exercise and good sleep might help too.

Whatever happens down there during pregnancy, know that things usually go back to normal after your baby is born and you’ve had some time to recover. As long as you are taking good care of yourself, these are just more of the weird but normal changes that people experience during pregnancy. But it’s important to set reasonable expectations for your recovery. It took many months of body changes to get your baby born, and it can take just as long or even longer for things to return to a more normal look and feel. Taking good care of yourself also means taking it easy on yourself

Your vagina and labia and vulva should go back to looking like they did before, and they should go back to feeling normal again too. It just takes a little time and care and patience. If they don’t, you can definitely see a specialist to help. Depending on the issues, you may see your primary care provider, or get a referral for a urogynecologist or a pelvic floor physical therapist or other specialist that can pinpoint the problem and help you recover.

References

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8232816/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9366906/

https://www.ajog.org/article/S0002-9378(17)30641-5/abstract

https://www.frontiersin.org/journals/molecular-biosciences/articles/10.3389/fmolb.2021.656844/full

https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0249925

https://www.texaschildrens.org/content/wellness/changes-during-pregnancy-whats-normal-and-whats-not

https://www.nhs.uk/pregnancy/related-conditions/common-symptoms/vaginal-discharge/

You might want to start doing things to prepare for your baby’s arrival, but it might feel too soon to do very much. You might have to wait a few weeks to start your prenatal care. Some people want to start telling people about the pregnancy, but others choose to wait. It’s too soon to shop for maternity clothes or baby things. It’s too soon to plan baby showers and work on the baby’s room.

When it’s too soon to do everything, you might want to start with these things instead:

Education

You can start the Healthy Pregnancy course now! It’s never too soon to start learning about your pregnancy and your health. This free self-paced online course will show you ways to stay healthy and keep you feeling good.

Your healthcare

Prenatal care is critical during pregnancy and it starts during the first trimester. Regular checkups will track your progress and your healthcare provider can watch for any concerning signs or symptoms. Prevention and early detection can help avoid bigger health issues.

You may visit with a doctor, midwife, or nurse before your first official prenatal appointment to confirm your pregnancy or your due date. Pregnancy tests that you can buy at the store tend to be very accurate, but some people want more confirmation.

If you’re unsure about your conception date, they may offer to do a dating ultrasound. Since it will likely be very early in pregnancy and the baby is very small, it will probably be a transvaginal ultrasound. They use a wand inserted vaginally to get closer to the uterus to see the baby.

Later in the first trimester, usually between 8-12 weeks, you’ll have your first prenatal care checkup. This one will usually be more comprehensive than the regular checkups after that. The first one may include:

• A thorough physical exam including:
  • Breast exam
  • Pelvic Exam – They may collect a sample for a pap test and cultures if you’re due for one.
  • Blood pressure
  • Weight
  • Urine collection – test for infections and disease indicators
  • Blood collection (CBC, Blood type and Rh Factor) – The Rh Factor test is to determine the compatibility of your blood type with your baby’s. In rare cases, they are incompatible. Finding out early means you can get medication that will prevent complications.
• Family & Health History – It’s very important to be thorough and give complete information. Your healthcare provider will not judge you, but they do need to know everything so they can best help you have a healthy pregnancy. This includes knowing about any medications or supplements you might be using
• Healthy Pregnancy Counseling – In some cases, you will get some education about how to take care of yourself best during pregnancy.
• Pregnancy Symptoms – Your provider will want to know if you are having any symptoms and may offer some help for discomforts.
• Emotional well-being – Your provider may ask about your mental health. It’s important to be open and honest. If you’re struggling with high levels of stress or any mental health conditions, it’s a good idea to get support or treatment as soon as possible. Your provider may be able to provide a referral or other resources to help you.
• Weight gain – Your provider may make suggestions about a goal for weight gain. The recommendation should be made according to your pre-pregnancy weight, your current weight, and also your other health factors. Too much or too little weight gain can impact your health, but a complete health picture is important. Weight gain that falls outside of normal ranges balanced with a healthy diet and exercise may not be as impactful as more average weight gain with an unhealthy diet and lifestyle. .
• You may get some education about the benefits of breastfeeding.

Genetic testing

You will likely be offered the option of genetic testing. Some people choose to get more detailed genetic testing during pregnancy. In the first trimester, it is more accurate to call this a screening. These screenings look for certain markers that might indicate a genetic condition. They do not necessarily mean that there is a problem, and they don’t diagnose specific conditions. If you have testing done and your results indicate that there could be a problem, it’s important to remember that very often, these don’t lead to anything. Further testing is needed to know for sure, and then to find out a specific diagnosis.

This kind of testing is optional. It’s not considered standard prenatal care. Because it is not standard prenatal care, you may not have insurance coverage for the testing. You might opt for this if you have certain risk factors including:

• Family history of certain genetic conditions
• Maternal age over 35
• Previous miscarriages or stillbirth
• An older child with a particular birth defect

It can be a difficult decision to do this even if you have risk factors. Knowing the results may or may not have an influence on how you choose to move forward in pregnancy. For some people, not knowing is very stressful. For others, knowing would be more difficult. It’s important to do some introspection and ultimately do what’s right for you. If you do decide to do the testing, you can ask for a referral for genetic counseling. This is very helpful for knowing exactly what the testing is for, how to interpret results, and also to help you manage your expectations and emotions.

Consider birth and find a provider

Think about your birth. What do you want it to be like? Your preferences are very important. Once you have a clear picture of what you want for your birth, you can start looking into options for your care and a location.
You might begin by checking insurance benefits and doing a little research into hospitals and birth centers in your area. Some people choose home birth and would want to start looking for a qualified midwife. It’s best to start your search as soon as possible, so you can initiate prenatal care with the provider that you will most likely be with for the rest of your pregnancy., Also some providers might book up and stop taking new patients. These are the options for birth locations:

• hospital
• hospital birth center
• free-standing birth center
• home

And these are options for prenatal care providers:

• Maternal Fetal Medicine doctor (MFM)
• Obstetrician (OB/GYN)
• Family Practice Physician
• Midwife
  • Certified Nurse Midwife (CNM)
  • Certified Professional Midwife (CPM)
  • Certified Midwife (CM)

In some cases, people might choose to have prenatal care with one provider, but then give birth with another. An example of this might be in areas where maternity care is very limited and the nearest hospital might be very far from home.

Focus on finances

This is a good time to find out about your workplace policies for maternity leave, and then have some thoughts and conversations about your financial situation. Some people might realize they don’t have a lot of paid maternity leave, but can choose to take some unpaid maternity leave. You may understand that you will need to go back to work at some point, and you’ll need to consider the cost of child care. You might determine that you need to start saving money for unpaid maternity leave or child care.

The first trimester is not too soon to create a savings plan and start saving. It’s also a great idea to find out if you qualify for special pregnancy/early parenting programs such as WIC or the Nurse-Family Partnership. Check for national, statewide, and programs in your local area and get signed up! These programs can help you save money and stay on track financially.

To tell or not to tell

You may decide to tell everyone about your pregnancy right away. You may decide to wait until after the first trimester. Other people take a middle road and just tell a small number of people. There is not one right way to handle this. You should do what works for you. If you’re excited, it’s very reasonable to want to share that excitement with people who will share it with you. If you’re very nervous or freaked out, it’s also reasonable to want comfort from loved ones, so you’ll need to tell them. On the other hand, if you feel like telling people will cause more stress for you, it’s also OK to keep it to yourself for some time.

Your pregnancy is a special time, and only happens once per child. Even if you’re feeling overwhelmed or miserable and sick, I love to recommend commemorating this time in some way. You might want to write in a journal, or take a lot of “before” pictures. What did you look like? What did your home look like? You can make audio or video recordings talking to your baby or just recording your thoughts and feelings. Someday soon your child will be very real and with you. Someday that person will probably be interested to see what you were like then, what you were thinking and feeling.
You’ll probably be so glad that you did it.

How will I look?

You will likely not look much different during the first trimester. Most people don’t start to have a belly bump until 12 weeks or more. Your uterus is swelling, growing, and will start to move up, but it’s not quite visible on the outside yet. You may notice some breast swelling and enlargement.

Self-care

It’s never too soon in pregnancy to start taking good care of yourself. In this case, self-care just means doing things that will keep you healthy and feeling good. A lot of what happens during pregnancy is not under our control, but some things are. These are some things you can do to keep yourself feeling good and even lower your risks for complications and increase your chances for great outcomes.

• Eat well – Great pregnancy nutrition can start now. On the other hand, this might be the time when it’s most difficult to eat well. If you’re having morning sickness, it can be hard to eat much of anything. But when you can eat a mostly balanced diet focused on protein, healthy fats, complex carbohydrates, and lots of colorful fruits and veggies, you’ll probably end up feeling better during the first trimester. There is even some research to show that great nutrition can reduce your risks for certain complications. You do not have to be perfect to get lots of good nutrition.
• Sleep well – Listen to your body’s need for rest. You are not lazy if you have to take some naps. It’s best to start with your nighttime sleep. Try going to bed at the same time each night, and wake up at the same time each morning. Give yourself an 8-10 hour window for nighttime sleep. If you have trouble sleeping, maybe make that window a little on the longer side! Eventually, you will probably start to be able to sleep well during that window. It can take some adjustment though, so give it a couple of weeks before you decide it’s not working. Remember to put away all screens at least 30 minutes before getting in bed. It can be hard, but probably worth it.
• Exercise – If you can get in some exercise, it’s shown to benefit you in so many ways during pregnancy. It doesn’t have to be a lot. Even just taking a 30 minute walk is great exercise. It’s shown to lower your risks for things like preeclampsia, gestational hypertension, and gestational diabetes. It’s also likely to help you feel better and sleep better. It’s best not to start a big new exercise program during pregnancy unless it’s one especially designed FOR pregnancy. Stick with things you already do unless it hurts or feels wrong in some way.

Remember that most people only realize they are pregnant halfway through the first trimester. So by the time you find out you’re pregnant, you’re halfway there! The first trimester can be a very challenging couple of months, but for most people it will change and often gets better.

If you don’t feel like you can do very much during the first trimester, keep hope that you will probably feel better and have more energy to do things later. Your body is already doing a lot. It’s very hard to see, but so much work is happening. You are growing a baby, but also a lot of energy during the first trimester is going into growing your new organ, the placenta. That needs to happen early and quickly so that your baby can start to benefit from it. Try to see the hardships as a reminder of the very hard and important work that your body is doing. Take it easy on yourself!

So much happens during pregnancy that is outside of our control. We don’t get to decide the baby’s exact genetics, or where the placenta decides to attach to the uterus. Each baby is different, and every pregnant body handles pregnancy differently. That can be VERY hard for the control freaks out there to accept. I can definitely include myself in those numbers. I don’t like it when I can’t control everything!

What happens to the body during pregnancy is stunning, and sometimes disappointing. There are countless amazing things happening in there to grow a new organ and a new baby, and sometimes things go a little sideways.

Preeclampsia is a condition that most people don’t hear about until they are pregnant.

During routine prenatal care, your provider is watching carefully for any signs of this condition. They take your blood pressure at each appointment and check your urine for proteins. They may ask you to watch for certain symptoms that could indicate illness if they see some telling signs.

What is Preeclampsia?

Preeclampsia is a high blood pressure disorder that occurs during pregnancy that can cause organ dysfunction. Most of the time, it gets worse toward the end of pregnancy, and can even sometimes show itself during the first couple of weeks postpartum.

The most common treatment for this condition is to get the baby born. If preeclampsia is suspected, you will likely be offered an induction if it’s not too early. The symptoms usually go away pretty quickly once the baby is born. If it’s too early for an induction, there are other treatment options including medications for blood pressure, bed rest, closer monitoring, and possibly hospitalization and other medications to prevent seizures.

Minimizing the Risk

This article is about some good news though. There are some things that are within our control.

There are ways that we can lower certain risks. Through scientific research, we are learning that there are things that we can do to keep ourselves healthy and minimize the chances that things will go sideways. Of course there are no guarantees that things will go perfectly even when you take all the right precautions, but those of us who love control out there might be happy to snatch up any opportunities!

There is still a lot to find out about pregnancy and nutrition, but there is a lot of information out there already. We know more everyday about healthy levels of protein and fats. There are new versions of prenatal vitamins coming out all the time with a better balance of nutrients. There is more helpful nutrition advice for managing morning sickness, and there is even some research offering guidance for the prevention of preeclampsia through nutrition.

It can be so hard to monitor what you’re eating during pregnancy. Sometimes it’s hard to eat anything at all, and other times it’s hard NOT to eat a certain food everyday for every meal. These guidelines for lowering your risk for preeclampsia through nutrition offer suggestions for ADDING certain foods and nutrients into your diet. You don’t necessarily have to stop doing everything that you’re doing, but can you ADD some things?

First, Whole Foods

A basic guideline for most anything related to nutrition is to focus on eating whole foods as much as possible. When you are eating whole foods, you’re most likely to hit the other goals listed below.

A whole food looks like what it is. It’s an actual orange instead of orange juice. It’s a bowl of brown rice instead of rice cakes or crackers. Try whole wheat bread instead of refined flour white bread. Have salad and all the fruits and veggies. Have meat, eggs, and even many whole milk dairy products. Oatmeal, nuts, and seeds are whole foods. There are plenty to choose from, and when you stick to mostly these kinds of foods, you’re probably doing a great job!

Sticking to whole foods is good for everyone, and especially when you’re pregnant and trying to lower your risk for preeclampsia. When you’re eating whole foods, you’re getting everything that food has to offer. You get the complex carbohydrates, protein, fats, fiber, and also all of the vitamins and minerals and other micronutrients. When food is refined or processed, some of the food’s value is lost and you don’t get the full benefit. When people eat a mostly whole foods diet, the risk of preeclampsia can go down.

Protein is Good for Everything!

You may have learned that the newest recommendation for protein intake during pregnancy is 80-120 grams per day. That’s a lot! This shows a range, because you can start out pregnancy with less protein and then your needs increase as your pregnancy progresses. Especially when you’re getting your protein from whole food sources like meats, whole milk dairy products, nuts, seeds, eggs, and legumes, you’re also getting some other important nutrients that can be helpful in preventing preeclampsia.

Higher levels of protein are also shown to reduce some other pregnancy discomforts and risks, and keep you feeling your best. Many protein rich foods are also high in glycine, which is especially good for keeping your blood vessels healthy which can help prevent preeclampsia.

Antioxidant Rich Foods

Antioxidants are especially important, because it’s thought that preeclampsia is caused by oxidative stress. Our bodies have ways of fighting oxidative stress, but sometimes it’s not enough, and that’s when antioxidant rich foods can be helpful.

Vitamin E and flavonoids are excellent antioxidants and can be found in a lot of foods, mostly seeds, nuts, and colorful vegetables and fruits. There are a lot of different kinds of flavonoids, so be sure to eat lots of different fruits and veggies to get the most variety for the most benefit.

Minerals

A lot of people get deficient in certain minerals during pregnancy, even when taking prenatal vitamins. It’s important to also get plenty of these minerals from food sources. Food sources are often better than supplements. You’re more likely to absorb the nutrient better and get the most from that nutrient AND all of the other benefits from the food. Some of the minerals that you might want to focus on for preeclampsia prevention include:

• Sodium: You don’t need to limit salt intake, especially in pregnancy! The general rule is that you can “salt to taste.” If it tastes like the right amount, you’re probably doing just fine. Salt restriction has not been shown to lower blood pressure for preeclampsia. In fact, research shows that MORE salt can actually lessen the severity of preeclampsia….. as long as you’re also getting plenty of potassium.
• Potassium
• Magnesium
• Calcium

These minerals are found in many whole food sources including colorful vegetables, especially leafy greens, but also nuts, whole milk dairy products and some meats and seafood.

Watch your Blood Sugar

In general, eating a lot of sugary foods is a bad idea. You won’t be able to feel your best. You may be more irritable, have low energy, and have more trouble sleeping and exercising.

It might be obvious that you should minimize the ice cream, candy, cookies, and cake, but it’s also important to watch the kinds of carbohydrates you are consuming. Remember to focus on the whole foods! When you do that, you likely won’t get much of the bad carbs.

This piece is critical when you’re working to keep your blood sugars stable. Keeping your blood sugars stable can help prevent preeclampsia, but also gestational diabetes! So whenever you can, focus on the complex carbs which only include WHOLE FOOD sources like fruits and vegetables and whole grains.

I hope you feel inspired to take some simple steps to better health and preeclampsia prevention. It often is very simple to make these positive changes, even if it feels intimidating at first. Take some small steps. Buy some extra eggs and fruits and veggies from the produce section next time you’re at the grocery store and see if you can work those in more at snack time and meals. Buy yourself a roasted chicken and add that in whenever you can for a protein boost. After a little while, you might even like the way you feel so much that it’s easy to keep it up.

Resources

Much of the information for this article is from Lily Nichols, RDN, especially the article PREECLAMPSIA: 5 WAYS NUTRITION SUPPORTS BLOOD PRESSURE IN PREGNANCY

Other resources:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5551541/
https://www.hsph.harvard.edu/nutritionsource/vitamin-e/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3650511/
https://ift.onlinelibrary.wiley.com/doi/10.1111/1750-3841.12101
https://www.aicr.org/resources/blog/flavonoids-in-your-foods-where-to-get-them/
https://www.hsph.harvard.edu/nutritionsource/potassium/
https://ods.od.nih.gov/factsheets/Magnesium-HealthProfessional/
https://www.hsph.harvard.edu/nutritionsource/calcium/

Resources:

Maternity Care in the United States compared to 10 other Developed Countries
Midwifery credentials in the U.S.
2023 JAMA Network Article Maternity Care Deserts in the US
2022 March of Dimes Report on Maternity Care Deserts
History of midwifery care in America

Although it is a very normal thing, most people are surprised when they leak from their nipples during pregnancy. You might wonder what it is, whether it’s normal, and whether it means anything.
The answers are:

1. Colostrum
2. Yes
3. Not really

You have everything you need installed and ready to make milk by the time you’re about halfway through pregnancy. By 16 weeks, some people might notice some leaking or be able to squeeze out small drops of a milky substance. That is called Lactogenesis 1. I love the word lactogenesis. If you break it down, it just means the origin of milk. For Lactogenesis 1, your body has done the work of creating and expanding milk ducts or glands (alveolar buds). You’ll probably notice some changes in the breast tissue while this is happening. They may get larger and more tender at times. Even if you can’t see much change on the outside, it’s still most likely that things are happening on the inside.

Once you reach that point in your pregnancy, you might notice some leaking, or you might not.

What is it?

Colostrum is the name for the milky substance you might see during pregnancy. For most people, it will be a very small amount, just an occasional drip. You might notice a discolored wet spot on the inside of your bra. You might see some drips if your nipples are stimulated by friction from clothing or with sexual arousal.

Colostrum is special, because it’s your body’s first milk. Once your baby is a few days old, you will make a different kind of milk. Colostrum has more of the things a baby needs immediately after being born. They don’t need a lot of food yet, but they do need more immunoglobulins, the immune system enhancing antibodies that your body has developed to help protect your baby from illness.

The milk also needs to feed your baby’s very new microbiome. A microbiome is a little community of microbes that lives within the body. Those microbes are a combination of bacteria, fungi, parasites, and viruses. This might sound bad, but a microbiome is actually considered a supporting organ. Those bugs co-exist and work together to keep you healthy. We all have many microbiomes that are responsible for all kinds of bodily functions. The biggest microbiome is in the intestines. When a baby is born, they have a pretty sterile gut. They need to develop a microbiome there so they can digest food and support good immune function. They receive a good dose of microbes from their mother during vaginal birth and skin-to-skin contact, and then the colostrum helps it thrive and multiply so your baby can start digesting food and fighting off infections.

Is it normal to leak milk?

It is normal to leak milk during pregnancy, although most people don’t. Most of the time, the milk doesn’t start coming out until after the baby is born. Lactogenesis 2 occurs once the baby is born and the placenta comes away from the body. The detachment of the placenta triggers a big drop in progesterone levels which allows your body to be flooded with a hormone called prolactin. That’s another great word! If you break it down, it means for lactation.

That hormone is responsible for Lactogenesis 2, which is where the milk is released. During pregnancy, the prolactin is mostly held back by high levels of pregnancy progesterone. If the prolactin level gets to be higher than the progesterone level at some points, that means some leaking. It’s not the most usual thing, but it’s very normal.

Does it mean anything?

Since leaking is considered normal, it definitely does not mean that anything is wrong. As long as it looks normal, you don’t need to worry. Colostrum is thicker than the milk you might be imagining, and it might be sticky and yellowish. If you notice any blood or discoloration, you may want to tell your doctor. It’s very important to remember two things:

1. Leaking doesn’t mean that you have too much milk, or that breastfeeding will be somehow easier or better for you.
2. If you don’t leak, it doesn’t mean that you don’t have milk or that you will have a hard time breastfeeding.

Since Lactogenesis 1 means you have all the equipment you need to feed your baby, you might think about collecting some colostrum while you’re pregnant. Even if you are not leaking, you will likely be able to do this. Prenatal colostrum collection means that you collect and store colostrum to use after you give birth.

There are a lot of great reasons to do this, especially if you think there could be some obstacles to breastfeeding in the early days because of a medical condition. For most people, it’s very safe to start expressing breast milk starting at about 36 weeks of pregnancy. There are some conditions that might make this less safe, so be sure to talk it over with your care provider.

We have a great guide for how to collect the milk when you’re ready. Hand expression is the preferred method for getting the colostrum out. Using a pump is not ideal because there is such a small amount of milk available.

In one of our weekly support group discussions, a second-time mama shared about being diagnosed with a VERY rare and weird pregnancy condition. It might not surprise you to hear that there are a lot of weird things that can happen to a pregnant body!

You might get the expected weirdness and discomfort like morning sickness, swollen ankles, stretch marks, hemorrhoids, heartburn, constipation, bad sleep, hip pain, back pain, a giant alien belly, and plenty more. You’ll probably need to pee too much and sometimes leak. This is all weird, but expected.

Some itching during pregnancy is also normal and very common, especially around the belly as it stretches. You might even develop stretch marks. This skin stretching can cause some itching, but it’s usually pretty mild and passes quickly or comes and goes. In some cases though, people develop some weirder and much more rare itchy conditions like PG, PUPPS, or Cholestasis.

Itchy and Uncomfortable Conditions which are Not Dangerous

Most itchy conditions are uncomfortable and troubling, but not dangerous.

• Prurigo of pregnancy is an itchy rash usually on the outside of the joints of the legs and upper arms (knees and elbows) and possibly the belly. This kind of rash is not harmful. It can be uncomfortable though, so a lot of times the symptoms will be managed with steroid creams, oral antihistamines, or other topical creams. This rash usually goes away pretty quickly after birth.
  Pruritic folliculitis looks sort of like acne and it is usually found on the shoulders, upper back, arms, chest, and abdomen. This rash goes away within a month or two after birth.
• Pemphigoid gestationis (PG) is one I just learned about. I’d never heard of it, because it only occurs in about 1 in 40,000 pregnancies. It seems to be caused by an autoimmune process, and it’s more common in people with light skin. It looks sort of like a poison ivy rash. It appears during pregnancy, usually during the third trimester, and goes away soon after birth. It doesn’t seem to cause any serious health issues, but it’s SUPER uncomfortable and looks scary. The mom I saw shared that the doctors had never seen it before, and it took some time to finally diagnose her. The right medicine is helping keep it under control. The usual treatment involves steroid creams, and when that doesn’t work, a regimen of oral steroids. It usually goes away within a couple of months of giving birth. It can come back in future pregnancies, but not always. When it does recur, it might start earlier and get worse, so make sure to keep an eye on it!
• PUPPP is one of the most common rash and itchy conditions that can develop in pregnancy. PUPPP stands for Pruritic Urticarial Papules and Plaques of Pregnancy. Phew! I got to see a case of this one a couple of years ago. It is a VERY uncomfortably itchy condition, also rare and weird, but mostly harmless. It looks like a red bumpy rash. The cause is mostly unknown, although there are a few theories. There is some evidence that it is an allergic reaction caused by quick and late stretching of the skin. It often starts in the stretch marks and then can take over. It’s a lot more common when people are carrying multiples and when people gain a lot of weight. Both of those things mean more stretching of the skin. Fortunately, even if it does continue through the pregnancy, it will definitely go away after. It’s rare for it to last more than 4 weeks, and it’s not likely to come back in future pregnancies. It’s just one of those weird pregnancy things.

Potentially Dangerous Condition

Then there’s an itchy pregnancy condition that can be very uncomfortable AND potentially dangerous. If you experience any of the symptoms of this condition, let your care provider know quickly.

Cholestasis is an itchy condition that has come up a couple of times listening to birth stories, so I thought I’d mention it here. It’s caused by an issue with the liver. When caught early enough, it can be managed well, but it might mean induction a couple of weeks before your due date. This condition is rare and weird like the others, but this one can cause some complications, so diagnosis and treatment is important. Something extra strange about this one is that the itching occurs without the appearance of a rash, and often on just the hands and feet.

The cause of Cholestasis is mostly unknown. It seems to be pretty complicated, but there could be a genetic component and a relationship with very high estrogen levels. It may also be more common in people with selenium and vitamin D deficiencies.

Cholestasis usually comes on late in the 2nd trimester or the first part of the 3rd trimester, usually after 30 weeks. The itching is most commonly on the palms of the hands and soles of the feet and might be worse at night. Some people will also have other symptoms like nausea, fatigue, insomnia, pain in the top right area of the belly, darker urine, and lighter colored poo. Some people might even notice some yellowing of the skin and eyes (jaundice). For most people though, the itching is the main or only symptom.

To diagnose it, doctors will usually order some blood work to test your liver function. If you have the classic Cholestasis itching along with certain lab values, you might be diagnosed with it. At that point, it’s most likely that you’d receive regular doses of a medication that usually improves liver function and reduces itching.

Within a couple of weeks, most people see a lot of improvement. The drug of choice seems to be very safe for babies and is most often effective. There are other medications that can be tried if the first doesn’t work, and most often, early delivery is recommended. Depending on the liver function tests, it might be recommended sooner or later. Most often, induction would be recommended between 36-39 weeks.

What Can You Do About Being Itchy While Pregnant?

If you develop an issue with itching or a rash during pregnancy, I’m so sorry! It’s a good idea to tell your care provider even if you know it’s not something dangerous. If they can give you a clear diagnosis, it might help you find some remedies to ease the discomfort. Depending on what kind of itching you’re having, certain things might work well or not at all. It always helped me to remember that these kinds of things will not last forever! In the worst case, you will almost definitely see it resolve after your baby comes.

It feels unfair to me that some people have to go through so much during pregnancy! Some people seem to sail through it without much discomfort, but most people experience a long list of pregnancy irritations. Isn’t it enough to have to carry around a giant belly and push a baby out? That’s already a lot of work!

Fortunately, most pregnancy symptoms are harmless. Unfortunately, a lot of them also don’t have a good cure. You might just have to bear with it until it passes or until the pregnancy is over. I like to think that all of these discomforts make birth seem like a great alternative. Instead of dreading birth, some people start to look forward to it because it will be a relief from these discomforts!

References

Pemphigoid Gestationis
PUPPP
Cholestasis
Descriptions of Pregnancy Rashes/Itching

Prenatal education usually means that you learn about birth, recovery, and baby care while you’re pregnant. There are so many different ways to do this. We are lucky to live in a time where information is at our fingertips. However you learn best, you can find a way to get the information.

Why is prenatal education important?

There has been a lot of research investigating this question. Does it actually help people to take classes while they’re pregnant? And how?

It seems pretty clear that it does help. The research evidence does vary on how and how much though. Some research shows that perinatal education can lower risks for pregnancy and birth complications, improve birth outcomes, lower cesarean rates, improve the way people feel about their birth experiences, and increase breastfeeding rates. Successful outcomes depend on a lot of factors, but you should feel confident that you are doing a good thing by getting this kind of education.

The type of class matters too! Some classes provide you with more or better information than others. It’s important to explore your goals before choosing a class. If you want to have an unmedicated birth, you should take a class that focuses on that. If you know you will be having a C-section, there are classes to help you prepare for that. If you know you want to breastfeed your baby, you should definitely get prepared by taking a class so it can be an easier transition for you. If you know you have to go back to work very soon after having your baby, you might want to take a class to learn about pumping your breast milk.

There are so many topics and options out there, it can be hard to decide. I think the best thing to do is decide what your overall vision is for your childbearing year, and then find the classes that can help you achieve it. Then find the kind of class that you think will be the most fun and convenient for you so that you can learn best and enjoy it.

How to Get your Prenatal Education

There are definitely benefits and drawbacks to all of the different ways of learning and methods for education. There are so many types of classes out there!

• Private classes.
• Public classes offered by varying health authorities or non-profit organizations such as WIC.
• Hospital based classes taught by nurses or educators.
• Education offered in OB, midwifery, or doula practices for their clients as part of their prenatal care.
• There are also some hybrid offerings out there. Breastfeeding Success is a great example of this. We are a private company, but we also partner with some local hospitals to provide services to their clients. Because we are an in-network care provider, we can also help people get their perinatal education covered by insurance and we can offer financial assistance although we are not a non-profit.

There are also different levels of expertise when you’re considering which teacher to choose. There are…

• Certified instructors. For example, for childbirth education, there are many different paths to certification, but their training is specifically geared toward providing childbirth education. These instructors can choose who to train with for their certification depending on their own interests and who and where they plan to teach.
• Professional instructors. These are not necessarily trained educators, but people in different professions like nurses, doctors, midwives, doulas, or lactation consultants who offer classes in an area that they specialize in. For example, a labor and delivery nurse might offer childbirth education classes at their hospital, or a lactation consultant might offer breastfeeding or pumping classes.

It’s also a great idea to consider the particular “method” an instructor might be offering. At Breastfeeding Success we take a very universal and evidence-based approach to education and try to include a little of everything in our offerings. Our instructors work to stay up-to-date and relevant, so that you can have the best information possible.

Some people like to choose a very specialized approach to their education. Childbirth classes are a great example of this. Some people want to have an unmedicated birth, so they would choose from methods that can help support that goal. You might choose a Lamaze class for a more general “natural” approach, or Hypnobirthing if you are a person who values meditation and deep focus. Or you may choose Bradley Method classes if you have a very involved partner and like the idea of a coach-focused method. Those are just a few of the MANY methods for learning about childbirth!

How to Receiving Training

And then you need to consider how you’ll show up for class.

Live virtual classes are taught by a live instructor just like an in person class, but it’s all done online. They meet using Google Meet or Zoom or another similar platform. You can see the instructor and possibly some of the other students. You can interact with the instructor and the other students by using a chat box or by using your microphone to speak. The instructor is most always on camera and you can see and hear everything.

Sometimes instructors will use physical teaching tools to illustrate concepts and support your learning. For example, I have a model of a pelvis and a baby doll that I use to show how birth works. I hold it up to the camera so everyone can see. A lot of instructors might also use digital teaching tools like a slide presentation, videos, or digital whiteboards to help with the teaching.

• Benefits:
  • This is a very convenient way to learn because you don’t have to travel or do much to prepare. You just turn on your computer or even just your smartphone, and you’re in class. You can take a class from anywhere in the world using this technology.
  • You might be better able to focus on the class content in this kind of class. Some people find it hard to focus in a room full of other people.
  • You can get very comfortable in your own bed if you want to! You can move around, have your own snacks, keep the temperature just the way you like it.
  • If there is a pandemic, you can’t get sick by taking a virtual class!
  • If you have children, you might not have to worry about getting childcare if you’re taking a virtual class at home.
  • These are sometimes less expensive than in person classes.
• Drawbacks:
  • Some people already spend too much time in front of a screen and do not want to take a class that involves more time at a screen.
  • Some people have trouble focusing unless they are physically in the same room with the teacher and students.
  • Especially if you are an extrovert, it also just might not be as fun when you can’t interact with other people. It’s often true that students don’t turn on their cameras for class, and it can be hard to connect with the people in the class or even feel like there are other people there.

In person classes are taught in an actual physical classroom. There is a teacher and there are other students in the same room with you. This is how most of us experienced school, until recently! Depending on the teacher, there might be a lot of props and visuals to illustrate concepts and help you learn. Like the virtual classes, there may also be a slide presentation to go along with the lesson and even videos and whiteboards.

• Benefits:
  • You get to meet other people who are pregnant, and it’s likely they live nearby. People can much more easily develop friendships and community by going to in person classes and groups.
  • Some people learn better this way. If you have trouble focusing on a screen for too long, this might be the way to go.
  • If the class is at your hospital, birth center, pediatrician’s office, or a place that it can help to get familiar with, you can benefit from knowing the location better.
  • You might feel like it’s easier to ask questions and get the information you need in this format.
  • Taking a class with a partner can be a great way to have a night out doing something new and different from the usual date night. It can be a great way to connect.
  • If you have children, it can be a good excuse to take a little break and get some self-care in.
• Drawbacks:
• • You have to travel to the class. That might mean fighting traffic, burning a lot of gas, dealing with frustrating parking situations, etc.
  • It means more time away because of the travel, so if you have a very tight schedule, it might be more difficult to fit it in.
  • If you have children, you will likely have to find childcare. That can be too expensive or too complicated for some people.
  • The classroom setting might not be comfortable for you. Sometimes it means hard and uncomfortable chairs, or the room is too hot or too cold, or you have to sit next to someone who can’t stop coughing!

Online classes are ones that you can purchase and complete on your own time. These can usually be purchased online, and then you receive access to the course via a link. It might be a multimedia class experience that includes handouts, videos, assignments and activities along with recorded instruction or without. It might also be a recording of an instructor going through the entire course with you. These might include a lot of information and be very long, or they might be very simple and short. There are a lot of options out there for these types of classes and they range greatly in quality and cost.

• Benefits:
  • You get the information on your own time. If you are getting REALLY close to your due date and can’t find a class to fit in before your deadline, this might be the best way to go. If you have a very complicated schedule, this might also be a good option for you since you can complete it whenever you have time. You can also take as many breaks as you need and you don’t have to worry about interruptions.
  • These are often offered at a lower cost than live taught classes, although some of them can still be quite expensive.
  • There are a lot of options for online classes!
• Drawbacks:
  • Most people don’t finish them. It can be hard to stay motivated when you’re not accountable to anyone for your attendance.
  • It might be less entertaining. Without the live interaction, many people find they get bored with this kind of learning.
  • You don’t get to ask questions, so you might be left needing to know more.

Hybrid classes use a combination of methods for providing the information. You might meet in person for one or more of your class sessions, and virtually for the rest. The class might also be completely online. In this case, you might have one or some live virtual meetings and then do the rest of the class on your own time by watching videos or completing assignments.

What is Prenatal Education Exactly?

What do you want or need to learn about? Prenatal education might include some or all of the following topics:

• Childbirth
• Breastfeeding
• Newborn care
• Healthy pregnancy or prenatal care
• Child or infant development
• Infant sleep
• Postpartum recovery
• Self-care/mental health
• And there are other topics related to health and parenting to learn about too!

If I could give everyone COMPREHENSIVE and complete prenatal education, I would. Of course, as a parent, childbirth educator, and the manager of a Parent Education Program, I would say that! There is so much to know when you are expecting a baby for the first time.

You want to consume as much information as you can. You might feel like this will help guard against problems. Or you might just want to go with the flow and just see what happens.

I think a healthy approach is to do as much as you need to lower your stress levels and feel confident. This might mean doing nothing, or this might mean doing EVERYTHING. For most people, it’s somewhere in the middle. Getting some information does make most people feel more prepared and confident. You also don’t want to go overboard though! Knowledge can’t guarantee a perfect outcome. Try to avoid too many Google searches, and if reading every book on the shelf is just making you feel like you need to read more, you’ve probably done too much. That’s what prenatal education is great for. If you can take a few good classes and leave it at that, you’ll probably feel better, be prepared, and even increase the probability that everything will turn out great.

Below is a recorded interview with Omaira Hanif, RN, IBCLC. Omaira works mostly with people immediately following birth. She works in the hospital setting as a lactation consultant (IBCLC). She is highly trained in the clinical management of lactation and helps people get a good start. Omaira is also a nurse who visits new families in their homes. Her job is to check on the babies, new moms, and the family, but also to educate. She spends a lot of time explaining what is normal and when they might need extra help.

Omaira is also a teacher! She teaches a breastfeeding and newborn care class. She feels very strongly that all families would benefit from prenatal education. She has noticed that when families have received some education about breastfeeding and newborn care, they don’t need her help quite as much after the baby arrives! Although she loves to be needed, she most of all wants parents to succeed while feeling confident about their own abilities.

Citations showing benefits of prenatal education:

• Quoted from Pregnancy Risk Assessment Monitoring System Survey “According to NJ PRAMS data, NTSV mothers who took a childbirth education class were 30% less likely to have a C-section and 3.7 times more likely to initiate breastfeeding compared to NTSV mothers who did not participate in a class, after adjusting for race/ethnicity, education, insurance payor type for delivery, and knowledge of risks/benefits of C-section versus vaginal delivery.”
• Mueller CG, Webb PJ, Morgan S. The Effects of Childbirth Education on Maternity Outcomes and Maternal Satisfaction. J Perinat Educ. 2020 Jan 1;29(1):16-22. doi: 10.1891/1058-1243.29.1.16. PMID: 32021058; PMCID: PMC6984379. Quoted from the study findings. “Attendees of a childbirth class were exclusively breastfeeding at a rate of 95% versus 78% of non-attendees.”
• Zafman KB, Riegel ML, Levine LD, Hamm RF. An interactive childbirth education platform to improve pregnancy-related anxiety: a randomized trial. Am J Obstet Gynecol. 2023 Jul;229(1):67.e1-67.e9. doi: 10.1016/j.ajog.2023.04.007. Epub 2023 Apr 11. PMID: 37054807; PMCID: PMC10330277. Quoted from the study findings “Patients in the intervention arm were more likely to breastfeed at delivery.”
• Yohai, David, Alharar, Debi, Cohen, Ruthi, Kaltian, Zohar, Aricha-Tamir, Barak, Ben Aion, Saviona, Yohai, Zehava and Weintraub, Adi Y.. “The effect of attending a prenatal childbirth preparedness course on labor duration and outcomes” Journal of Perinatal Medicine, vol. 46, no. 1, 2018, pp. 47-52. https://doi.org/10.1515/jpm-2016-0345. Quoted from the study findings “Women in the study group rated their labor experience significantly higher (P=0.016) and exhibited significantly higher rates of breastfeeding (P<0.001) than controls.”
• A Guide to Effective Care in Pregnancy and Childbirth (3 edn); Murray Enkin, Marc Keirse, James Neilson, Caroline Crowther, Lelia Duley, Ellen Hodnett, Justus Hofmeyr; Published: June 2000

If you are currently pregnant, it might surprise you to hear that you should probably start thinking about choosing a pediatrician for your baby now. Babies born at a hospital usually get their first checkup with a pediatrician the day after they are born. That checkup is most often provided by the hospital’s staff pediatrician and you don’t need to worry about it. In some cases, your own family’s pediatrician may be the one to perform this exam in the hospital and you’ll need to provide contact information for your doctor. Be sure to find out what you need to do by asking your care provider or hospital maternity unit.

After that initial checkup, the standard schedule for doctor visits in the first year goes like this:

• First doctor visit happens when your baby is about one week old.
• One month
• Two months
• Four months
• Six months
• Nine months
• One year

That’s seven visits just for check-ups and vaccinations! If your baby needs to see the doctor because they are sick or have something else going on, you get to add to that number of visits. Because you will be seeing this care provider so often, it’s a great idea to choose well and to choose now. Some doctors have very full schedules and it can be hard to get the appointment times and days that you prefer, so finding that person now and getting your appointments scheduled is smart.

How Do You Choose a Pediatrician

Depending on where you live, there may be a lot of doctors to choose from and it can be difficult to sort through the options and pick the right one for you and your baby.

I like to recommend that people start by deciding on what kind of doctor they want to see. Most people choose a pediatrician. Pediatricians specialize in working with young people from birth through adolescence. There are only children being seen at a pediatrician’s office, so they have all the right small equipment for the job and often staff who are especially good with kids. A bonus is that they are usually fun and have cute decorations and toys for the benefit of the little people.

Other people might choose a family practice doctor. These providers work with people from birth through death. They often have children as patients, but see people of all ages. Their offices might not be geared towards children, but they do have everything they need to provide care to your young ones. Another benefit of establishing a relationship with a family practice doctor is that your whole family can see the same provider.

I personally started out with a pediatrician for my children, but when I had to choose a new practice because of a change in insurance, I decided to switch us all to a family practice. I really enjoy this, because our doctor knows us all, and everything is in one place. That makes things simpler for me.

Whatever you decide, the next step would be to find out who is in network with your insurance company. That will ensure that you get the best coverage.

Once you have that list, you may still have a lot to sort through, so think about these things:

• Where is the office located? When you have to make so many visits, it can start to feel inconvenient to drive across town, especially if you have a baby or toddler who doesn’t love being in the car for long periods of time.
• How is the parking situation? Is getting in and out of the office convenient and simple? It can be extra frustrating to have to park far away or in a big garage when you’re lugging around a big diaper bag, a baby, a stroller, etc.
• Are they taking new patients? Finding out now is a great idea because if you wait to establish care until your baby is born, you might be told that they are not taking new patients and you’ll need to start over.
• How far ahead do you have to schedule visits? If you’re a long distance planner, this might not matter to you. If you sometimes wait until later to schedule things, you might get disappointed when you’re told you’ll have to wait a month or more to be seen.
• Will you be able to see YOUR chosen doctor for most visits? Even sick visits? Some practices are small and it can be easy to schedule with your favorite provider, but others are very large and you may never get to see the doctor you thought you were choosing.
• Does your doctor have a partner for coverage when they’re away? If you need to see a doctor while your doctor is not available, who is there?
• Do they have in-house diagnostics? If your child needs something like an x-ray or blood work, are they able to handle that in the office or would you need to be sent somewhere else?
• Do they have long waiting room waits? Some care providers do a great job of ensuring that you rarely have to wait much before your appointment time, but others are chronically behind. This might start to matter a lot when you’re spending a lot of time there with a baby!
• Do they have separate waiting rooms for sick visits and well visits? If you’re just there for a check-up and a vaccination, it might be uncomfortable to be in a waiting room full of sick kids.
• How are you treated while you’re there? You should feel comfortable with the staff at your doctor’s office. Are people friendly? Do they listen well? Do you feel like they are knowledgeable and competent? Are they also flexible and willing to seek outside advice when they’re not sure about something? Do they take your concerns seriously? I definitely switched away from a doctor who made me feel like I was a silly and overly worried first time mom. I wasn’t, and I found a doctor who took my concerns seriously. Your parental intuitions matter, and you and your doctor can be a great team when you can work together!
• Do your philosophies align? You don’t have to agree on everything, but there are often many different ways to handle issues with your children. You might not feel comfortable giving certain medications or agreeing to certain procedures if there are alternatives. You can find a doctor who will either agree with you or at least respect your preferences. That’s important.

When my first baby was about 9 months old, our pediatrician started asking me when I would begin weaning her off of breastmilk. She was doing great, I was very comfortable with breastfeeding at that point, and I knew the latest recommendations said that breastfeeding for two years is ideal! When I told her that I didn’t intend to stop breastfeeding anytime soon, I felt very judged, so I found a new doctor who celebrated my choices and made me know that I was doing a great job.

Doctors are Not Always Experts in Parenting

It’s also important to remember that although doctors are very important for your child’s health, they are not necessarily the right person for every job. They are not necessarily parenting experts who can tell you the best ways to get your child to sleep better or eat better or to ask about discipline. They often get asked for this kind of advice, however, and will probably try to do their best to help. But it’s good to remember that they are offering opinions and that there are many right ways to parent a child. It can be reassuring when you and your doctor are on the same page.

It is very appropriate to call different providers and ask these questions. Doctors often get requests for appointments for interviews or a call for general information about their practice. You will not be the first parent to do this. It’s a great way to find the right care provider on your first try, and could potentially save you time and frustration in the future.

I like to think of it like choosing a stylist to cut my hair. There are so many ways to cut and style hair well, but only a few that I like for myself! If I get a haircut that I don’t like, or have a hard time getting an appointment time, or don’t like the smell in the salon, I find someone else to do it next time. I consider the whole experience when choosing a professional for this job, and we should do the same when making decisions about healthcare.