Pregnancy, birth, and the postpartum time are full of decisions: choosing a care provider for your pregnancy and birth; defining and communicating your birth preferences; making choices about newborn medical procedures, feeding, and care; and more! Each of these choices is affected by a variety of factors!
As a doula, I love supporting my clients through the process of making their own informed, empowered decisions. I love watching my clients research their options, consider all the relevant factors, and move forward with the best choice for their family and circumstances.
One of my absolute favorite tools for informed choice is the BRAIN acronym.
The BRAIN acronym guides parents through each part of making a choice. For each choice, it invites you to consider:
Benefits: What are the possible benefits of making this choice?
Risks: What are the potential risks of making this choice?
Alternatives: What alternatives can we consider? (For each alternative, you can go through the BRAIN acronym again!)
Intuition: What is my intuition telling me is the best choice for our family?
Nothing: What if I do nothing?
Let's walk through an example of how to use this acronym. Let's say, for instance, that you're trying to decide where to give birth. The BRAIN acronym works best if you choose a potential decision and work through the acronym, and then do the same thing for each alternative choice. For this example, you may begin by considering the decision to give birth at a birth center. You'd start by looking into the options near you. (In Utah county, you can check out Utah Birth Suites, Two Leaves Midwifery, and Birthing Your Way. The Draper Beautiful Mountain Birth Suites birth center is also right on the border between Salt Lake and Utah counties.)
Next, consider the BENEFITS of giving birth at a birth center. Perhaps you like the homey feel of a birth center (compared with a hospital). You may appreciate that a birth center offers a large tub, spacious rooms to labor in, and places for your family or friends to wait. During COVID specifically, birth centers are much less likely to restrict the number of support people you can have with you during your birth. There are also fewer routine interventions and procedures done in a birth center (compared with a hospital), and you're more likely to know everyone in the room. You may also want to read this blog post about the evidence on birth centers and ACOG's Statement on Birth Settings, which lists accredited birth centers as one of "the safest places to give birth." Throughout your research, you'll find other benefits to list as you consider making this choice.
After thinking through the BENEFITS of birthing at a birth center, research the RISKS. Think specifically about your situation and the potential risks of birthing at a birth center. If you have a high responsibility pregnancy (what some may call "high risk"), a birth center may not offer access to medical care you need. If it's likely that your baby or babies will need additional medical care at birth, a birth center doesn't have immediate NICU access. If you are planning to use epidural anesthesia during labor, this option isn't available at a birth center. And you won't stay for 24-48 hours after giving birth, but will head home within a few hours of giving birth. What other risks might be important for you to consider?
After thinking about the RISKS, ask yourself about ALTERNATIVES. Alternatives to birth centers include hospital birth and home birth. Some inns/hotels are also open to having clients give birth there (Aspenwood Manor in Provo is a beautiful option that is very open to this!) Again, for each of these possibilities, you'll want to go through the BRAIN acronym again!
Next, tune into your INTUITION. You are the only one who knows all of the factors in your unique situation. Do the work to familiarize yourself with the options and their benefits and risks, and then trust your intuition. Reflect, ponder, meditate, pray. Talk it through with your spouse/partner/doula/friend/mom/aunt/yourself. And trust that you can make the right decision for your family!
The last letter of the BRAIN acronym doesn't really apply in this scenario: doing NOTHING in your decision-making process about birth location would eventually lead to an unplanned home birth, which isn't a great option. (Planned home birth can be, though--stay tuned for an upcoming post about that!) In other situations, though, NOTHING, can be a worthwhile option to consider. Rather than consenting to having your water broken, you can choose to do NOTHING to intervene. NOTHING can also mean letting NATURE take its course, which is an option you'd want to carefully consider.
I hope that example exercise was helpful! I love that the BRAIN acronym is applicable for everything from choosing a care provider to induction to anesthesia to breastfeeding to potty training to choosing a preschool and beyond! It's a great tool for parenting!
I love that this acronym recognize and invites YOU to be the actor, the decision maker, the researcher (in consultation with care providers, medical experts, and others as needed) in your own story. Whenever there's a choice to be made, ask yourself: What are the Benefits, Risks, and Alternatives to the proposed choice? What is my Intuition telling me? What if I do Nothing?
3-5% of Americans are vegetarian, and I'm one of them!
(Well, strictly speaking, I'm a pescatarian. I do eat fish.)
People have a variety of reasons for choosing vegetarianism, from ethics to environmentalism to religion to health to personal preference. But when you're growing a whole new person, you may wonder: is it still safe and healthy, for both my baby and me, to continue being a vegetarian?
The answer is yes! You can continue being a vegetarian and still meet all of your and your baby's nutritional needs. It may take some careful planning and thoughtful eating, but you can do it!*
Just keep these guidelines in mind:
Be sure to get enough iron.
Iron is important for your red blood cells to do their job of circulating oxygen throughout your body! Eating a diet rich in Vitamin C will help you body absorb iron more efficiently. Vegetarian sources of iron include:
Track your sources of vitamin B12.
Vitamin B12 is crucial to the healthy function of your nervous system, among other roles. Since vitamin B12 is found almost exclusively in animal sources, you may need to plan carefully to make sure you're getting enough.
Vegetarian sources of vitamin B12:
Protein is important!
The American Pregnancy Association recommends 75-100 grams of protein per day during pregnancy. There are plenty of vegetarian sources of protein, so make sure to include them in your diet! Here are some ideas to get you started:
Choose a variety of healthy foods.
Vegetarians and non-vegetarians alike should follow this advice: eat a balanced range of healthy food choices throughout your pregnancy. Limit unhealthy snacks and eat a rainbow of delicious, nutritious foods!
Always talk with your care provider.
As a doula, I love to provide informational support to my clients. However, I'm not a medical care provider, and I don't know your unique medical history. Be sure to have conversations with your midwife or OB about your diet and health throughout your pregnancy!
Now you have the Reader's Digest version of being vegetarian during pregnancy. If you decide it's the right choice for you, please do more research and make a plan for meeting your nutritional needs! You can start with the references listed below.
*Note: Some people may choose to take a break from vegetarianism while pregnant. If your intuition tells you that's the right choice for you and your baby, then do it!
Your Vegetarian Pregnancy by Dr. Holly Roberts (available in my lending library)
So, your due date has come... and gone...
First of all, let's be clear about EDDs, or Estimated Due Dates (also called Estimated Date of Delivery). You can tell from my italics that the term estimated is critically important in understanding due dates!
Where do due dates come from?
An EDD is calculated as 280 days past the first day of your last period. EDDs can also be determined by measuring your baby during an early ultrasound, which is a more reliable method.
Here's the thing about EDDs calculated as LMP (last menstrual period) + 280 days. There's lots of room for error with that approach. Many women misremember the first day of their last period and do their best to guess. Even if you're sure of your LMP, using this day to calculate a due date assumes that you ovulate on day 14 of your cycle and have 28 day cycles. The whole idea of EDD = LMP +280 days is also based on little sound evidence. Back in 1744, Dr. Boerhaave, a professor from the Netherlends, looked at data from 100 women and concluded that most people gave birth within about 280 days of their LMP (although he didn't specify whether LMP meant the first or last day of the menstrual period. In 1812, Dr. Carl Naegele further popularized this process of EDD calculation, but he used the last day of the period as the LMP. In the 1900s, obstetric textbooks started using the first day of the period as the LMP.) So the very process by which due dates are determined isn't very specific, and is based on very limited data!
It's tricky, then, if we take an EDD to mean much more than an estimate of when baby might arrive. As Rebecca Dekker of Evidence Based Birth concludes,
"Based on the best evidence, there is no such thing as an exact “due date,” and the estimated due date of 40 weeks is not accurate. Instead, it would be more appropriate to say that there is a normal range of time in which most people give birth. About half of all pregnant people will go into labor on their own by 40 weeks and 5 days (for first-time mothers) or 40 weeks and 3 days (for mothers who have given birth before). The other half will not."
Instead of fixating on a due date, you may prefer to refer to your EDD as a "guess date," or think more about your "due month" than a specific day.
Now that we have a better idea of where due dates come from and what they do--and don't--mean, let's talk about being "overdue."
As evidenced above, there's nothing magical about the 40-week mark. It's actually more likely that, if you wait to begin labor on your own, you'll give birth a few days past your EDD than on the due date itself. Babies aren't considered "late term" until you reach the 41 week mark, and "post term" doesn't apply until babies are past 42 weeks gestation. Induction for being "overdue" isn't recommended until you're at least 41 weeks pregnant.
It's almost as if pregnancy is trying to teach us the vital parenting skill of patience.
So, what's the takeaway?
Pregnancies aren't like final projects or rent due dates. No points are deducted or fees added for going past your due date. A due date just gives an estimate of when your baby is likely to be born, but really doesn't mean anything definitive. My advice is to schedule a week full of pampering and things to look forward to on your due date and the few days past it. Plan on getting food from your favorite restaurant, going for a walk in your favorite spot, connecting with friends or family. Practice some of those comfort measures that will come in handy during labor. Snuggle up with some great birth books. And know that your baby and your body will work together to signal when it's the right time for baby to come!
* * * * *
This whole business of calculating due dates and going past your due date is really quite complex. Now that you've been introduced to the topic, I recommend digging into it more with these two articles from Evidence Based Birth: The Evidence on: Due Dates and The Evidence on: Inducing for Due Dates.
When I say the words healthy eating, what are your first thoughts?
Eating healthy can seem like such a battle! No one seems to agree on what "healthy eating" really means, old habits can be hard to kick, and being pregnant can sometimes be rough enough to feel like you can justify eating whatever you want!
Let's break it down to five simple things you can start doing right now to give your diet a healthy boost! Your body will thank you! You'll feel better, and you'll be more confident that you're giving your baby the best start you can!
1. Drink. Water.
It's so important to stay hydrated during pregnancy! Your body needs water to pump all of your blood (you have 1.5 times your normal blood volume during pregnancy!) around your body to get all the good nutrients to your baby and get rid of any waste. Being dehydrated can also cause pre-term contractions, which is a scare no one wants to have to deal with!
If plain water isn't your favorite, try adding a squeeze of lemon or lime, or mix it up with some herbs or fresh cucumber slices. Aim for at least 8 glasses of water per day. You can do it! Carry around a water bottle, and make sure you have water cups or bottles in various rooms around the house so there's always water within arms' reach.
I also find that when I drink enough water, I make healthier choices about what I eat. So that's tip #1!
2. Focus on What You ARE Eating (Not On What You AREN'T Eating)
It can be so frustrating to feel like you have a mile-long list of "off-limits" food and drinks. Instead of worrying about what you shouldn't eat, you'll feel much happier if you focus on the healthy food choices you are making. Rather than agonizing over missing out on sweets or soda, shift your focus. Plan out a yummy, nutritious breakfast. Stock up on healthy snacks. Find food that you enjoy that is also good for you, so you worry less about what you're missing out on and focus more on enjoying the good food you're feeding yourself and your baby!
3. Choose Fresh Fruits and Veggies!
As I kid, I LOVED vegetables.
Yep, you read that right. Loved them! And I still do! In the summer, I would eat toast with tomatoes for breakfast and tomato sandwiches for lunch. My sister and I would play truth or dare so that we could dare each other to go pick us fresh peas from the garden. Broccoli has always been a favorite. Salad is legit my FAVORITE food. No joke. Yum... just writing this is making me want some!
What's the trick? I really believe it's because I grew up with a GIANT garden and got to taste the best of the best of vegetables and enjoy their freshness and flavor. Finding good-quality, fresh produce can make a huge difference in how enjoyable it is to munch away on fruits and veggies.
Summer and fall are a great time to find your local farmers market and buy some delicious food! The Provo Farmers Market is on Saturdays from 9-2, and at my visit last week I got some DELICIOUS peaches and plums and saw a huge variety of garden-fresh vegetables. Put it on your calendar and check it out! Note that there are some changes from the "norm" for COVID-19. Wear a mask and follow the one-way traffic signs so that it can stay open all season!
4. Find Your Favorite Protein
Protein is critical during your pregnancy! Find out what your favorite proteins are, and make sure you eat plenty every day. (The American Pregnancy Association recommends 75-100 grams per day!) Try pairing two incomplete proteins (e.g. rice and beans, peanut butter and whole grain bread) to get a complete protein. Here are some ideas for proteins to get you thinking:
And check out this post for more about being a vegetarian during pregnancy.
5. Kick Cravings with Go-To Favorites
Find some favorite healthy snacks for when you're craving junk food. I often find that if I want a sweet treat, an apple with peanut butter will hit the spot, and I feel way better after eating it than I do after giving into cravings!
If you sometimes eat too many cookies or potato chips, don't throw in the towel on your healthy eating plan. Keep moving forward with nutritious choices and give yourself grace to be imperfect--we all are!
Many of you may know that in addition to birth, my other passion is language. I believe that language is powerful and influential, and I dig into why this matters in the realm of birth over at my other website, Birth Words. I have a variety of offerings through Birth Words, from a podcast to classes for birthing families and birth professionals, and lots more.
I thought I'd update you all here with news from the Birth Words August newsletter, because there are a couple of exciting announcements relevant to birthing families! Check out the relevant bits below:
*NOTE: Check out the browser version of the full newsletter HERE!*
A new FREE PDF download for you!
6 Questions for a Better Birth
Six questions about language to ask yourself as you prepare for or support the BEST birth possible.
Visit www.birthwords.com to get this PDF in your inbox!
Birthing families, this one's for you!
(do you hear the drum roll?)
I've got a book coming for you!
Birth Word for Birthing Families will take your mind and heart on a journey from pre-conception through postpartum. At every stop along the way, we'll think about the impact of our words and the language that surrounds us.
If you want to be the first to know when the book will be available, sign up here!
Hi, I'm Sara. I'm a birth + postpartum doula serving Utah county. I'm a twin mom (plus one!), natural VBACer, and birth lover!