This is the first in a series of blog posts based on interviews I’m doing with midwives who serve Utah County. 

Today's interview is with Roxanna Maurer of Angel Baby Midwifery. Roxanna has been a midwife since she graduated from Utah School of Midwifery in 1998! She lives in Payson, Utah and attends home births in Utah County. Roxanna is a warm, loving, beautiful person—I hope this post captures some of that for you!

Last month, I chatted with Roxanna as she took a break in the shade from landscaping her backyard. She already has a thriving garden, and is expanding it with fruit trees and other plants. She shared her wisdom about the importance of good nutrition during pregnancy.

​When Roxanna takes on new clients, one of the questions she asks them is, Are you willing to take responsibility for yourself and your baby? Roxanna says, “I can talk to you till I'm blue in the face. But it's pointless if you go home and don't do anything about it.” This is especially important to Roxanna and her clients since all of her clients give birth at home. “Part of having home birth means I'm willing to take responsibility for myself,” she says. “That means you prepare for the marathon of birth.” And if you’re preparing for a marathon, you can’t be stocking up on candy bars and Diet Coke. Nutrition is critical.

So Roxanna shares a handy acronym to help her clients remember the critical nutrition components they need every day. The acronym was developed by her good friend and fellow midwife, Nikki Sasser. She says, “if you want to be a birthing queen, you need a WHOPPER every day.” And let me tell you, Nikki and Roxanna do not mean one from Burger King! (It’s also great advice for outside of pregnancy!)

W stands for whole grains. Roxanna’s disclaimer about whole grains? “I don't mean General Mills cereal that says whole grain on it because let's just be honest… it's not.” For those who are able to eat grains, she suggests oats, quinoa, millet, and brown rice as some delicious, nutritious options.

H stands for hydrate. Roxanna recommends drinking half of your weight in ounces of water. So if you weigh 160 pounds, drink 80 ounces of water every day. Coconut water is also a great source of natural electrolytes—like Gatorade, but “with all the good stuff and none of the junk.”

O is for omegas. Roxanna uses the acronym BACON to remember sources of healthy fat and omegas. Butter, Avocado, Coconut, Olive oil, and Nuts.

P stands for proteins. As your blood volume increases during pregnancy, it’s important to have adequate amounts of protein. Iron and B vitamins are also critical in promoting healthy blood quality during pregnancy and having the necessary stamina for labor, birth, and early parenting, Roxanna says. (Vegans or vegetarians may need to take a B-vitamin supplement, as B-vitamins are typically found in animal products.) What sources does Roxanna recommend for protein? Beef, chicken, fish, eggs, lentils, beans and rice, nuts and seeds, protein powder drinks.”Those are a variety of ways of getting proteins in your diet.”

The second P in the WHOPPER acronym is probiotics. Probiotics “colonize the gut and break down the food.” Roxanna recommends Standard Process’s Lactic Acid Yeast as a probiotic supplement.

E stands for enzymes. Probiotics help break down the food, and enzymes continue the process. “That's the purpose of enzymes, to help you digest your food effectively,” Roxanna says. A healthy diet only does you good if your body is able to adequately digest it! Multizyme from Standard Process and TerraZyme from doTerra are options for enzyme supplements.

Lastly, the R in WHOPPER stands for the Rainbow. Eating a rainbow of healthy foods invites lots of beneficial vitamins and minerals into your diet. Go through the rainbow, and try to incorporate foods of every color. Red berries and cherries or beets, orange pumpkin, yellow squash, green salads or smoothies, blueberries, and purple plums or grapes… you get the idea!

And there you have it! Roxanna’s WHOPPER for birthing queens! Changing habits and sticking to a healthy diet can feel overwhelming, but you can do it! Check out my Top 5 Tips for Healthy Eating During Pregnancy. And to encourage yourself, here’s Roxanna’s tip: “Take a picture of success that you've had in your life and hang it in your mind.” Keep going back to that success in your thoughts; refer back to it. As you recognize other successes you’re having, “bring that into your success gallery, and refer to that. I was strong here. I can be strong here. And if I'm strong here, what else can I do?”

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:

• legumes (lentils, beans, peanuts, etc.)
• eggs (if you eat them in your vegetarian diet)
• enriched grains
• leafy green vegetables
• dried fruit
• blackstrap molasses

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:

• dairy products
• eggs
• nutritional yeast
• vitamin supplements
• fortified foods

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:

• nuts
• tofu
• fish or seafood, if you're a pescatarian (make sure it's fully-cooked, and avoid deep-sea fish that can have high mercury content, like shark, swordfish, king mackeral, and marlin)
• beans and other legumes
• yogurt
• eggs
• quinoa

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.
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​
*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!

REFERENCES:
https://americanpregnancy.org/your-pregnancy/pregnancy-nutrition-1008#:~:text=Pregnancy%20Nutrition%3A%20Protein,in%20your%20increasing%20blood%20supply.

​https://my.clevelandclinic.org/health/articles/4724-nutrition-during-pregnancy-for-vegetarians

https://www.nhs.uk/live-well/eat-well/vegetarian-and-vegan-mums-to-be/

​Your Vegetarian Pregnancy by Dr. Holly Roberts (available in my lending library)

So, your due date has come... and gone...

​Now what?

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.

REFERENCES:

https://evidencebasedbirth.com/evidence-on-due-dates/

​https://evidencebasedbirth.com/evidence-on-inducing-labor-for-going-past-your-due-date/

https://www.acog.org/patient-resources/faqs/labor-delivery-and-postpartum-care/when-pregnancy-goes-past-your-due-date#:~:text=The%20date%20your%20baby%20is,last%20menstrual%20period%20(LMP).

https://www.acog.org/patient-resources/faqs/labor-delivery-and-postpartum-care/when-pregnancy-goes-past-your-due-date#:~:text=Labor%20induction%20may%20be%20recommended,This%20is%20called%20cervical%20ripening.

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!

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!

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!

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!

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:

• Chicken and other poultry
• Meat
• Fish
• Nuts and nut butters
• Lentils
• Beans
• Tofu
• Eggs
• Yogurt
• Quinoa

...And many more! Here's a list of other protein sources with the amount of protein in one serving so you can start adding up your favorites!

​And check out this post for more about being a vegetarian during pregnancy.

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!

This post is the fourth in a series about comfort measures for labor that appeal to each of the five senses. Today, we're focusing on the sense of touch! Check out these six ways that touch can help you manage labor.

Light Touch
(Photo by Isaac Ordaz on Unsplash)
In early labor, it may feel nice to have someone (your husband/partner, doula, friend, etc.) to lightly run their fingers along your arms, shoulders, back, or other places. The backs of the fingers work well for this, and the light, stroking motion should feel like a pleasant tickle, encouraging you to release any tension you may be holding. A head massage tool, like this one, gives a similar sensation for your scalp. Some people (e.g. me) love it, and some people (e.g. my husband!) hate it. ​

We've been preparing for this event for a loooong time. After multiple attempts to reschedule, we're excited to be offering this class in person at the beautiful Aspenwood Manor! You'll have a cozy spot six feet apart from other couples, and we'll have hand sanitizer on tap. :)
​
Join us for an engaging evening designed to strengthen your relationship and preparation for birth.

Whether it's your first baby or your sixth, come learn how to make every stage of labor progress more smoothly. You will move beyond feelings of uncertainty to claim your power as life-giving agents.

You'll learn and practice hands-on comfort measures so you can work together as a couple during labor.

A decadent dessert of warm Chip cookies served with locally made gourmet Rockwell ice cream will be provided, along with fresh fruit and cheese.

We're excited to see you!

It's been a while since I've posted here. Honestly, I've been pretty overwhelmed by the way the world has turned upside down in the last couple of months. I have struggled to know the best way to respond. Doula work has slowed for many of us, as most hospitals have limited hospital visitors (support people) to just one person. I've fortunately been able to support clients at a home birth and at the one hospital in my county allowing two visitors, and have advertised virtual doula support. But I'm so happy to say that better times are coming to Utah birthing families. And it starts tomorrow!
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You can read all the details here, but hospital policy is changing to allow TWO support people (visitors) at all Intermountain Healthcare facilities, so long as they are in good health, complete a screening (answer a series of questions--no long q-tips up the nose!), and meet a few other guidelines.

If you're looking for a doula now that we're able to be back in the hospital with you, Mary Caplin and I would love to set up a free consultation to see if we're a good fit!

Today, in the third post about comfort measures for labor that appeal to each of the five senses, we’ll be looking at your sense of taste… or at least, what you can do with your mouth to benefit your labor!

Eating During Labor
(Photo by Joseph Gonzalez on Unsplash)
Laboring and giving birth are hard physical work! You wouldn’t want to go for a long hike without anything to eat—your body would be tired and hungry, and it would make the hike feel ten times harder! The same is true for labor—you need energy from food to sustain you through it!

There may come a time in your labor when food doesn’t interest you, which is why it’s especially helpful to eat during early labor when you have an appetite. Don’t eat anything overly heavy or greasy, but do make sure you’re giving your body energy for the life-giving work it's doing!

Some people have concerns about the safety of eating and drinking during labor because some hospital policies have restricted it due to a concern about potential aspiration if emergency anesthesia was needed. Updated research and updated anesthesia technology show that low-risk birthgivers should have the right to choose whether to eat and drink during labor (you can read a detailed summary of current research and recommendations here​, at Evidence Based Birth).