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Welcome! I am a certified Birth Boot Camp instructor, teaching childbirth education classes in San Diego, CA. Please wander around my blog and feel free to contact me with any questions or comments that you might have.

Our mission: Birth Boot Camp is committed to training couples in natural birth and breastfeeding through accessible, contemporary education. Birth Boot Camp is for couples, moms AND dads. You’ll learn to work together to bring your baby into this world as a team.

Please Pass the Salt!

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One of my biggest pet peeves is the spread of misinformation, whether unintentional or deliberate.  Here’s a topic that has come up a couple of times recently with people I know: salt consumption during pregnancy.  A common train of thought seems to be that sodium causes fluid retention, which can lead to swelling, which is a possible sign of preeclampsia, and therefore pregnant women should cut all or most salt out of their diets.

This is, quite simply, not true.  Well, not entirely true, anyway.

Mamas, you need to be eating salt during your pregnancy.  But in natural ways; the need for sodium does not give you free rein to eat all of the fast food and processed packaged junk (most of which is completely loaded with salt) that you want.  Rather, most caregivers recommend that you salt your food to taste, preferably using the highest-quality salt you can find.  If you think your soup or your egg or your whatever needs a dash or two of salt at the table, then add some, by all means!

Here’s a simplified explanation.  Yes, salt does contribute to fluid retention.  However, this is necessary during pregnancy.  Most caregivers recognize that mild fluid retention in the feet and ankles is normal during pregnancy, even somewhat desirable, since it is a sign of your body having enough extra fluid.  (Note that while swelling in the feet and ankles is normal, swelling in the arms and face is not, and should be brought to the attention of your caregiver immediately.)  This extra bodily fluid is essential for your increased blood volume; while pregnant, you have about 40% more blood in your system, and limiting your sodium intake restricts this blood volume expansion.  Cutting back on salt will not lower your risk for preeclampsia; on the contrary, it seems increase your risk, according to some studies.  Additionally, you could be hampering your placenta’s growth and potentially hurting your baby.

One of the best explanations I’ve seen regarding salt during pregnancy comes from the Brewer Diet.  But every pregnancy book I own (and I own quite a few) that mentions salt specifically is in favor of including salt in your diet to taste.

From Pregnancy, Childbirth, and the Newborn by Penny Simkin:

“Experts know that gradual, moderate water retention in pregnancy is not only normal, but the extra fluid is necessary for an adequate volume of blood and amniotic fluid.  During pregnancy, consuming an adequate amount of salt helps maintain your fluid balance.  Feel free to salt your food to taste.”

From Eating Expectantly by Bridget Swinney:

“Sodium needs increase during pregnancy because of the extra fluid your body retains to cushion your baby… Some swelling is a normal part of pregnancy; cutting your sodium below what’s recommended won’t help and may hurt.”

From The Complete Book of Pregnancy & Childbirth by Sheila Kitzinger:

“It used to be thought that salt was dangerous in pregnancy and a cause of preeclampsia, but when a group of expectant mothers were given no-salt diets, they had more preeclampsia than a control group who had as much salt as they wished.”

From Heart & Hands by Elizabeth Davis:

“Contrary to popular opinion, salt is a necessary nutrient and should be used according to taste.”

From The Pregnancy Book by Dr. Sears (and also in the section “Satisfy With Salt” on AskDrSears.com):

“Unless advised by your health-care provider, you should not restrict your salt intake while pregnant.  Salt causes your body to retain fluid, of which you need more during pregnancy… Salt your food to taste.”

From YOU: Having a Baby by Michael F Roizen:

“Women may get cravings for salt because sodium is needed to balance their extra fluid volume during pregnancy.”

And lest you think that I only own weird, non-mainstream pregnancy books, it’s worth noting that even What to Expect When You’re Expecting by Heidi Murkoff says salt in moderation is good.  Even their website says “don’t blame salt for those puffy feet.”  Here’s what the book says:

“It’s believed that some increase in bodily fluids in pregnancy is necessary and normal, and a moderate amount of sodium is needed to maintain adequate fluid levels.  In fact, sodium deprivation can be harmful to the fetus.”

Your Pregnancy, Week by Week by Glade Curtis isn’t fully on board with the idea of salt to taste during pregnancy, but even they grudgingly admit that some is important.

“You do need some [salt] every day to help deal with your increased blood volume.”

So there you have it.

Were you concerned about salt during your pregnancy?

Why do I need a childbirth class?

I spend an awful lot of time talking to women about birth.  Aside from the fact that, as a childbirth instructor, it’s my job, I also just love listening to others tell their stories.  Everyone’s experiences with pregnancy, labor, and birth are so different, and I have heard stories from all across the board.

Here’s a comment I hear frequently:  “Why do I even need to take a childbirth education class?  I’ve read a few books.  Won’t my doctor tell me everything I need to know?”  Sadly, the answer to that is a resounding NO.  Reading is fantastic, and you can prepare yourself pretty well that way, but a good childbirth class can fill in the gaps and truly prepare you to have the amazing birth you want to have.  And as much as we want to believe that our care providers will educate us, the fact remains that you are only one of their patients, and their time is limited; even if they want to teach you all they know, they just don’t have time.  And many care providers, unfortunately, would be happier if you just did everything they said without question.

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You are doing yourself a great service by taking a childbirth class!  Educating yourself is never a waste of time, and will hopefully help you to have the birth you want.

Here are some other things I have heard:

“My doctor decided to induce me.  I didn’t want to be induced, but I didn’t think I was allowed to say no.”

In an ideal world, your caregiver would give you the facts about your & baby’s condition, give you the benefits and risks of all options available to you, and offer their professional opinion about the course you should take.  You could than use this information to make an informed decision about your care, and your caregiver would respect that decision, even if it was not their recommendation.  Unfortunately, we do not live in an ideal world.  Chances are good that your caregiver knows a whole lot more about pregnancy and birth than you do.  But chances are also good that they are considering factors beyond their own experience and your best interest when they make their recommendation.  You do have options, and your caregiver’s word is not law.  Informed consent means knowing both benefits and risks for any procedure, and it includes the right of informed refusal.  And a good childbirth class will teach you about risks and benefits of interventions before labor even begins, enabling you to make truly informed decisions regarding your care.

“After how hard the last labor was, we decided to just schedule a repeat c-section.”

I obviously can’t comment on the last labor, since I was not there and I do not know the full story or why baby was ultimately born via cesarean.  However, the fact remains that every labor is different.  Just because the last one was difficult does not mean that this one will be.  VBAC is safe, and in many cases it is safer than a repeat cesarean.  Labor is hard work, but it is worthwhile and you CAN do it.  A good childbirth class will cover VBAC, and will give you the information you need to achieve your birth wishes.

“They want to induce me at 39 weeks.  When I asked why, they said, ‘It’s just what we do.’”

Like everyone else who works in the birth world, I do not take issue with induction if there is a valid medical reason.  But there is something troubling about a caregiver who wants to take such a drastic step without providing any reason at all, much less a good one.  Early induction increases the likelihood of your baby needing a stay in the NICU; every day that your baby stays in the womb is beneficial for growth.  Early induction could be the start of the slippery slope known as the “cascade of interventions,” and if induction fails because your baby and your body just aren’t ready, there is a good chance you will end up with a cesarean.  A good childbirth class will help give you the confidence to stand up for yourself, and to demand legitimate answers to reasonable questions.

“After they gave me my epidural, they broke my water.  I didn’t even know they had done it until one of the nurses casually mentioned it later.”

Hearing things like this just drives me crazy, but it is becoming more and more common.  For some caregivers and hospitals, breaking a woman’s waters (the technical term is artificial rupture of membranes, or AROM) is such a standard procedure that the doctor doesn’t even feel the need to mention it to the mother.  This is just one of many reasons why it is so important to have a good labor support team, whether it is your partner, family members, a good friend, or a doula.  Your support people will know what you want out of your labor; if you’ve requested no routine AROM and they see your OB heading your way with an amniohook, they can tell you before it’s too late.  A good childbirth class will talk about your personal labor support team, including doulas; your teacher will likely even know a few if you are interested in recommendations!

“I hadn’t done any research on epidurals before going to the hospital; I had no idea I’d need a catheter!  I’m just glad my husband knew enough to explain things to me, because the nurse wasn’t helpful at all.”

Wouldn’t it be nice if your doctor/midwife/nurse took the time to explain these things ahead of time?  Unfortunately, that’s usually not the case.  Most caregivers recommend some sort of childbirth class during pregnancy (and even OBs will usually recommend at least the class offered at the hospital where you are giving birth).  The fact of the matter is that you cannot depend on your caregivers to provide you with all of the information you need, but a good childbirth class can.

“My doctor induced me a few days after my due date.  He said going post-date put my baby at risk.”

This touches on two things:

  • The “safest for baby” card: Naturally, no mother wants to put her baby at risk.  But using it as a tactic to scare a mother into what might otherwise be an unnecessary induction is just wrong.
  • Definition of post-date: The above quote is just flat-out inaccurate.  Recent studies have indicated that the length of a healthy, term pregnancy can vary by as much as five weeks, and even ACOG (the American College of Obstetricians and Gynecologists) recognizes that post-term is a baby born 42 weeks or later.  (Read about their recent statement regarding new definitions of term pregnancy.)

Sometimes, there is a good reason to induce around your due date.  Other times, there is no harm in letting baby stay put for awhile longer.  A good childbirth class will discuss what you may be faced with if you go past your due date, and will help you to understand when to let nature take its course and when to consider intervening.

“When I got to the hospital, I was in very early labor.  But I live 45 minutes away, so they didn’t want to send me home.  Instead, they broke my water to ‘get things moving.’”

The woman who I heard this from gave birth more than thirty years ago, but I’ve heard similar statements from friends who have given birth more recently too.  Nowadays, if they don’t just send you home for coming in that early, you’ll probably end up with Pitocin or some other form of augmentation.  (And that’s not even getting into the discomfort of several trips to and from the hospital and how it can potentially slow down labor, or the emotional upheaval that many women experience upon finding out that they have a long way to go!)  A better idea would be to find a nearby park and go for a walk; if you live really far away from the place where you will be giving birth, you might even consider renting a nice hotel room for early labor.  It’s important to remember that in many hospitals, once you have been checked in you are “on the clock.”  Many hospitals place rather arbitrary limits on how long a woman can be in labor for, and as you near that time limit they may start pressuring you to accept interventions that you do not want.  And if your waters are broken (or they do it for you), you are even more likely to face time limits.  AROM brings its own set of risks: there is an increased risk of cord prolapse, especially if done early in labor, and there is an increased risk of infection (a risk which rises further with each vaginal exam you receive).  Routine early AROM hasn’t been shown to provide very many benefits either; the hospital is not likely to go over the risks and benefits with you in detail before the procedure, but a good childbirth class will!  A good childbirth class will also help you know when is the best time to travel to your birth place (or when to call your midwife over if you’re birthing at home).

Please do yourself (and your baby) a favor and take a good childbirth class!  You will learn things you didn’t even realize you needed to know, and the knowledge you gain will ultimately help you to have the birth you want.

What do you call it when…?

Or: 7 Pregnancy/Birth Things You’ve Heard About But Don’t Know the Name For

The birth world definitely has its own lexicon.  Some words you may have heard before you got pregnant: placenta, trimester, contraction.  Some words have been given new or expanded meanings: presentation, heartburn, induction.  Other words may have become familiar friends as you worked your way through books or your childbirth class: doula, perineum, fundus.

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And then there are those words you can’t quite remember, or maybe you never really knew in the first place.  Words for things that came up during your pregnancy or a friend’s, things you’ve read about, things that you know about from somewhere but that you just don’t know what they’re called.  Want to expand your vocabulary a bit?  Read on for a few of those words.

1.  Amniotomy.  This is an easy one.  An amniotomy is the technical term for artificial rupture of membranes, otherwise known as when your caregiver breaks your bag of waters for you (as opposed to letting it break on its own).

2.  Chloasma.  Some women develop darkened patches of skin on their face while they are pregnant, a result of the extra hormones circulating in their body.  This is generally known as the “mask of pregnancy,” and is a common enough occurence to merit a mention in most pregnancy books, although I do not personally know anyone who has ever experienced it.  (I don’t think.  Do let me know if I’m wrong.)  The technical term for this is chloasma.  And thankfully, it almost always disappears once baby has been born.

3.  Supine Hypotension.  You know how your caregivers tell you not to lie on your back starting at some point around the end of your second trimester?  That’s because the weight of your growing uterus will put pressure on your inferior vena cava, the vein that carries blood from your legs to your heart.  This could cause a drop in blood pressure, reduce the blood flow to your placenta, and ultimately restrict oxygen to your baby.  This blood pressure drop is known as supine hypotension.  It *could.*  But you don’t need to worry if you flip onto your back while sleeping; chances are good that you won’t actually harm your baby.

4.  Nil Per Os.  Most hospitals in the US have a policy of not allowing women in labor to eat or drink.  This dates back to the 1940s, when it was discovered that aspirating food particles while under general anesthesia was a very real risk, and when general anesthesia was more common during labor for various reasons.  It was believed that by withholding food and liquids, a woman who unexpectedly had to go under was at less risk.  Nowadays, general anesthesia is much less common, and most anesthesiologists are much more skilled and use better techniques that minimize that risk.  In recent years, there has been much research done that proves that NPO, which stands for nil per os (which is Latin for “nothing by mouth”), is no longer an evidence-based practice.  Regardless, it is still standard of care in most hospitals.

5.  Valsalva Maneuver.  When you see people giving birth on television or in the movies, the pushing stage usually involves the woman being told to hold her breath and push as hard as she can for as long as possible.  Right?  There are various terms for this, such as “directed pushing” or “purple pushing,” but this is technically known as the Valsalva Maneuver or Valsalva pushing.  Well, if you really want to get technical, the Valsalva Maneuver is actually attempting to exhale against a closed airway and it has a few medical applications, not to mention being useful for “clearing” one’s ears.  But in the birth field, this style of pushing, which usually inadvertently produces the Valsalva Maneuver, is described using the same name.

6.  Nuchal Cord.  This is another straight-forward one.  A baby born with a nuchal cord simply means that the umbilical cord was wrapped one or more times around baby’s neck at birth.  About a third of all babies are born with a nuchal cord.  Contrary to popular belief, however, nuchal cords generally do not cause problems.

7.  Placentophagy.  During one of the childbirth classes I took when I was pregnant, I remember one of the other mamas blurting out something about crazy women who eat their placentas.  My husband quickly grabbed my hand and gripped it tightly, silently warning me to keep my mouth shut.  (There were a lot of instances in that class where I kept my mouth shut.  That was definitely not the right class for me.  But I digress.)  Placentophagy is simply the act of consuming one’s placenta after birth.  The most common form in our society is encapsulation, where the placenta is dehydrated and turned into pills.  (That’s what I did.  Yes, in case you were wondering, I totally ate my placenta.)  Some people eat it raw, or cook it in some way.  I’m not going to get too deeply into the why here, since there are plenty of perfectly good articles out there explaining it.  (Try this one at Placenta Benefits.)  Nor am I going to go into whether or not it’s effective.  I just wanted to make sure you knew the practice has a name.

I Love Babywearing!

Yes, that’s right, I LOVE BABYWEARING.  You know when you see parents walking around with their little one strapped to their chest or back (or hip)?  That.  Love, love, love.

I bought a Moby Wrap when my son was just a few weeks old.  My sister had used one with her son, and I thought it seemed like a neat idea.  It was relatively inexpensive as far as carriers go, versatile, and delightfully snuggly for my little guy.  We used the Moby for a few months, and I loved it!  And then soon after we arrived in San Diego, he began to refuse to go into it, presumably because the weather was warming up and he was just getting too toasty.

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Little Bug is just over a month old here, happy and snug in the Moby.

We bought an Ergobaby Carrier next, the performance model because it looked like it would be comfortable and more temperature-appropriate.  It seemed a bit expensive to me initially, but it was worth every penny and I tell everyone who asks about it now that it’s the most useful parenting tool I own.  Seriously.  It can carry a baby up to 45 pounds (my son is now about 25 pounds and he still loves riding in it), it’s small and compact, and it makes both of our lives better in many ways.

I personally have no experience with any other kind of carrier.  I have friends who have used ring slings, woven wraps, Beco carriers, Tula carriers, handmade carriers purchased from Etsy, and others.  I can’t tell you what kind you should buy, but as with all things parenting, I suggest you do your research!  Talk to friends, women from your local parenting groups, people you see at the mall.  Read reviews.  Please read about the importance of using an ergonomically-correct carrier and the risk of hip dysplasia from “crotch-dangler” style carriers.  Look for local groups or classes where you can try out different styles of carrier and learn how to use them before purchasing.  (Check out Babywearing San Diego or other similar groups in your area!)

Here are just a few of the things that I love about babywearing.

Babywearing helps you meet your baby’s needs.

Have you ever heard of the concept of the “fourth trimester?”  The basic premise is that human babies are born before they’re really developmentally ready because we have such big brains that we couldn’t fit through the birth canal if gestation lasted any longer.  Human babies are really quite immature at birth, at least when you compare them to other animal babies.  During the first few months after birth, babies to struggle to adapt to life on the outside, and this is part of the reason why so many babies just want to spend all of their time in someone’s arms.  One of the best-known books on this idea is The Happiest Baby on the Block, in which Dr. Harvey Karp offers suggestions for “recreating the womb” to soothe unhappy babies.

“Putting your baby in a carrier or a sling and taking him for a walk gives him three of his favorite sensations: jiggly motion, cuddling, and the rhythmic, soothing sound of your breathing.  These devices are great ways to treat our babies to a sweet reminder of the fourth trimester.”  Harvey Karp, The Happiest Baby on the Block

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It’s perfectly normal for your baby to want to be held all the time.  Babies need to be close to a caregiver; this is biologically normal.  Babywearing can help you meet that need.

Babywearing lets your baby get more out of life.

“Wearing humanizes a baby.  Proximity increases interaction, and baby can be constantly learning how to be human.  Carried babies are intimately involved in their parents’ world because they participate in what mother and father are doing. Consider the alternative infant-care practice, in which baby is separate from the mother most of the day… For the infant who lives alone, normal daily experiences have no learning value for him and no bonding value for the mother.  At best, baby is involved as a spectator rather than a player.”  William Sears, The Baby Book

When I am wearing my baby, he truly does get more out of life.  I carry on conversations with him.  He points at things, and I identify them for him.  He can see more than he can from a stroller, especially from a rear-facing infant stroller.  (And when he gets tired of looking at things, he can still snuggle against me and go to sleep!)  He can wave at pedestrians on the street, and they often wave back.  He can wave at big construction trucks stopped at red lights, and sometimes they honk their horns for him.

Compare that to the baby riding passively in a stroller.  Assuming he isn’t screaming and demanding to be held while his parents uncomfortably ignore him, everything is just washing over him.  His parents talk with each other, not with him.  People walking by don’t make eye contact.  He can’t really see much of what is going on around him.  Which baby do you think is happier?

Babywearing lets you do more.

There’s this meme I see floating around Facebook occasionally.  It has a picture of a man with a very strained expression on his face, and he’s carrying a handful of bags and a loaf of bread tucked under his arm.  The caption is “I’d rather break my arms than take two trips.”  This is my husband.  After we go shopping together, he divides all of our bags between his hands, or stacks boxes from Costco so high that he can barely see over the top, or otherwise does his best to bring everything inside in one trip.  Before our Little Bug was born, I’d share the load; once we were parents, my job was to carry our son while he carried everything else.

And then, when Little Bug was about seven months old, my husband left on deployment.  Suddenly I had to bring in groceries by myself.  Thanks to my trusty Ergo carrier, I could strap my baby to my chest or back and carry bags with both hands.  (For the record, I am not a pack mule like my husband.  I will make two or three trips if necessary.)  (Also, I call my husband a pack mule in the most loving way possible.)

With a baby carrier, I can do all kinds of things more easily.  With my baby attached to me, I can take trash and recycling out to the dumpster.  I can wash dishes.  I can vacuum the carpets.  I can eat with both hands.  I can nurse while doing my grocery shopping (and no one can even tell).  I can make it through airport security with ease.  When you have a baby who wants to be held all the time, as mine did, you can get a lot more done with the aid of a baby carrier.

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Helping Mama vacuum.

Babywearing gives you greater mobility.

When my son was around eight months old, I joined a meetup group for mothers whose babies were of a similar age.  One of the very first meetups I attended was at the mall.  There were six of us, if I remember correctly, and all of them were pushing strollers while I had my little guy strapped to my chest in the Ergo.  We were a force to be reckoned with, this parade of strollers carving our way through the crowds, filling the elevator to the brim when we went upstairs, walking two by two up the ramp and not leaving room for anyone else to get around us.  We kind of ended up with a marching order every time we headed to a new store, and whoever you were walking next to was who you were talking with until we stopped again, because with strollers it’s just not easy to switch places.  We had to use elevators and ramps, since strollers cannot traverse staircases, and if there was a slow- or non-moving crowd, we had to slowly wade our way through.

Watching others struggle with strollers is part of what convinced me to try a carrier in the first place.  With a baby in a carrier, you can slide through thick crowds with ease.  You can go up staircases (weighted stair climbing makes for fantastic exercise).  You can walk places where strollers do not dare to tread.  Beaches?  Easy hiking?  Gravel pathways?  All very doable with a carrier.

At the top of Cowles Mountain in San Diego.

At the top of Cowles Mountain in San Diego.

And don’t go thinking that carriers become obsolete once baby starts walking.  As I mentioned earlier, I still wear my little guy almost daily.  Sure, I love letting him walk on his own and explore the world.  But sometimes I just want to, you know, actually make it to a particular destination within a reasonable amount of time.  Or go shopping without just following him around and telling him not to pull things off the shelves.

Babywearing can help make you healthier.

Before you ask, no, I do not get some misguided sense of superiority from wearing my baby.  (And yes, I have had that “argument” lobbed at me before from people who do not agree with or approve of my intuitive, attached style of parenting.)  What I’m going for here is that babywearing can help you get more exercise, both because of increased mobility and because, well, when you walk or hike you’re carrying the added weight of your baby.  I personally believe that babywearing helped tremendously as I slowly lost my baby weight.  (It took awhile, but I was in no rush to get rid of it either.)  Note that I don’t say anything about my “prepregnancy body.”  I am not in nearly as good of shape as I was before having a baby, since walking and hiking are just no substitute for the cardio kickboxing and intense strength workouts I favored before I got pregnant (and for a good chunk of my pregnancy too).  But babywearing does turn walking into a more effective form of exercise.  And if you hike up a mountain with a baby on your back, you will find yourself both short of breath and rather sore the following morning (although you will also get some admiring looks from other hikers).  There’s even an actual Babywearing Workout DVD that you can try, should you so desire.  (I have not, although I would like to.  Well, maybe not with a squirmy toddler.)  Babywearing has definitely helped me to be healthier.

Do you wear your baby?  What do you love about it?

The Rh Factor & Your Pregnancy

Rhesus (Rh) incompatibility is a pregnancy topic that is very near and dear to my heart, since my blood type is Rh negative and my husband’s is Rh positive.  My midwife discussed it with us early in my pregnancy, and I spent a lot of time researching it on my own.

What is the Rh factor?  There are four main blood types – A, B, AB, and O.  Blood types are further classified according to whether or not there is a specific protein found on the surface of the red blood cells.  If the protein is there, the blood type is Rh positive.  Otherwise, your blood type is Rh negative.  About 83-85% of people are Rh positive, meaning 16-17% are Rh negative.

Why does it matter?  Most of the time, it doesn’t.  The one time it is really important, though, is during pregnancy.  If a woman who has Rh negative blood is pregnant by a man whose blood is Rh positive, there is at least a 50% chance that the baby will also have Rh positive blood.  When an Rh negative mother is pregnant with a baby who is Rh positive, it is called Rh incompatibility.

If Mom’s blood is exposed to Baby’s blood, her immune system will recognize the Rh protein as a foreign substance and will produce antibodies in response.  (When this happens, the mother is now Rh sensitized or isoimmunized.)  Those antibodies can in turn cross the placenta and enter Baby’s bloodstream, where they will attack Baby’s Rh positive red blood cells.  If Baby’s blood cell count gets too low, he could develop hemolytic disease.

What happens next?  Depending on when sensitization happens, the result could be mild or severe or somewhere in between.  If a baby develops hemolytic disease while still in the womb, intrauterine blood transfusions may be necessary to stabilize Baby’s blood cell levels.  The most common result of hemolytic disease is severe anemia at birth, but it can also cause jaundice, or even brain damage or heart failure.

Don’t freak out yet!  If this is your first pregnancy, there is likely not much to worry about.  During pregnancy, your blood and your baby’s blood do not usually intermingle; the risk of isoimmunization during pregnancy, especially a first pregnancy, is only about 2%.  Some things that can put you at risk for isoimmunization are:

  • amniocentesis
  • chorionic villus sampling (CVS)
  • bleeding during pregnancy
  • blunt trauma to the abdomen
  • placenta previa
  • placental abruption
  • prior miscarriage
  • prior termination
  • external cephalic version (to turn a breech baby)
  • ectopic pregnancy

How can I prevent Rh sensitization?  The most common medical way is through the use of injected Rh immune globulin, most commonly known as RhoGAM.  Referred to as a blood-based vaccine, RhoGAM contains antibodies to the Rh protein, is believed to destroy fetal blood cells in the mother’s blood supply before her blood has a chance to make her own antibodies against them.  It is administered as an intramuscular injection, usually into the buttocks.

Most doctors want to give pregnant women a prophylactic dose of RhoGAM at 28 weeks; this provides the mother with a passive immunity in case of slight placental tears or some other form of trauma.  RhoGAM is also given if a Rh negative woman undergoes amniocentesis, CVS, or some other invasive form of testing.  According to the package insert, “if RhoGAM is administered… early in pregnancy (before 26 to 28 weeks), there is an obligation to maintain a level of passively acquired anti-D by administration of RhoGAM at 12-week intervals.”  This is because RhoGAM is thought to only be effective for 12 weeks after you receive it.

The Rh protein is present on the blood cells of an Rh positive baby starting around 8 weeks.  So if miscarriage or termination occurs after that, or an ectopic pregnancy lasts at least that long, then there is a risk of isoimmunization.

Otherwise, RhoGAM is recommended to be given within 72 hours of delivery if the baby has Rh positive blood.  (After birth, a simple test of the cord blood can determine the baby’s blood type.)  If Baby has Rh negative blood too, than RhoGAM is completely unnecessary.  The 72-hour-deadline is somewhat controversial; there is little information one way or the other regarding effectiveness after that time period.  The package insert does say that in one study, RhoGAM provided protection in 50% of women who were given it 13 days after delivery.

Note that RhoGAM does not do any good if it is given after a woman has become sensitized.  To be effective, it must be given before isoimmunization occurs.  And once a woman becomes sensitized, those antibodies are with her for life.  Any future pregnancies will automatically be considered high risk as a result.

Is Rh immune globulin safe?  Of course (say the manufacturers)!  RhoGAM is made using antibodies derived from human plasma, but the donors of the blood have been “carefully screened by history and laboratory testing to reduce the risk of transmitting blood-borne pathogens.”  The plasma undergoes fractionation and filtration to further ensure safety of the finished product.

As with any pharmacological product, RhoGAM has side effects.  These include: injection site reactions (swelling, redness, mild pain, warmth), skin rash, body ache, headache, fatigue, and slight elevation in temperature.  Also possible are signs of a hemolytic reaction, which may include: fever, back pain, nausea, vomiting, hypo- or hypertension, hemoglobinuria/emia, elevated bilirubin and creatinine, and decreased haptoglobin.  Allergic reactions are rare, and no fatalities due to anaphylaxis have ever been reported.  The package insert indicates that you should be observed for at least 20 minutes after receiving the shot, presumably to watch for signs of allergic reaction or other severe side effect.

RhoGAM is a Pregnancy Category C drug.  According to the package insert, “The available evidence suggests [RhoGAM] does not harm the fetus or affect future pregnancies or the reproductive capacity of the maternal recipient.”  Suggests.  For the record, Pregnancy Category C is described thus: “Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.”  Basically, the FDA does not know whether or not RhoGAM is safe for your baby.  But they believe the benefits to the mother outweigh potential risks to the baby.

Some babies have been born with minor Rh sensitization, presumably from prenatal exposure (that prophylactic dose at 28 weeks).  This fact is confirmed by the product insert.

The Healthy Pregnancy Book says, “If within a couple of days after birth baby tests Rh positive, baby may also be given an injection of RhoGAM.”  The book does not say what the purpose of this administration would be.  The package insert, however, expressly instructs, “Do not inject the newborn infant.”

Other concerns about RhoGAM are related to the other ingredients.  RhoGAM was once formulated with thimerosol, which contains mercury, but does not seem to be anymore.  (This is hard to confirm.)  There are still fairly widespread concerns that RhoGAM may contain mercury or aluminum, although RhoGAM’s website declares that it contains no preservatives.

Is it effective?  Studies seem to indicate so.  Rates of isoimmunization vary depending on the source. Up to 10-14% of women may become Rh sensitized without RhoGAM.  That number drops to less than 2% when RhoGAM is given postpartum, and to 0.1-0.2% if given during pregnancy as well.

How else can I reduce my chances of becoming Rh sensitized?  The most important thing you can do is to be as healthy as possible during your pregnancy.  Here are some other ideas:

  • Make sure your diet has adequate protein.  A pregnant woman needs at least 80 grams of protein daily.  For that matter, make sure your entire diet is healthy.  A whole foods diet will help make your placenta as strong as possible, which will reduce your risk of isoimmunization.
  • 1000mg of vitamin C daily may help strengthen the membranes.  Vitamin C is necessary for tissue repair and wound healing, and your body needs it to produce collagen (see next bullet point).
  • Avoid fluoridated water and toothpaste.  Fluoride has been shown to interfere with collagen production, and collagen fibers are what attaches the placenta to the uterine wall.
  • Take 1 gram of powdered activated charcoal daily; activated charcoal absorbs toxins in your system, which can keep you from getting sick.  Do not use at the same time as you take any other supplements, because it may interfere with absorption of them.
  • Take 1 teaspoon of magnesium powder dissolved in water daily.  Among other important functions, magnesium helps your body build and repair tissues.
  • Kelp, sea vegetables, and mineral supplements can help strengthen the placenta.  Sea vegetables are a good source of iodine, a lack of which has been linked with preterm birth and miscarriage.  Kelp also contains potassium, calcium, and iron.
  • Take 1/2 cup of elderflower infusion daily.  The use of elderflower in pregnancy is considered controversial by some (discuss with your care provider first!), but it is thought to be helpful for anti-inflammatory purposes and detoxification.  It contains antioxidents, which help protect you from cellular damage.
  • Consider delayed cord clamping.  According to Sheila Kitzinger in The Complete Book of Pregnancy & Childbirth, “If a woman is Rh negative with an Rh positive baby, there is a case for delayed cord clamping.  If the cord is clamped while still pulsating, fetal blood is retained in the placenta, blood vessels rupture as the uterus contracts, and the chances of Rh positive blood being pushed back into the mother’s bloodstream are greatly increased.”
  • Let the third stage of labor progress at its own pace and avoid cord traction, especially before the placenta has separated from the uterine wall on its own.
  • Consider placentophagy.  According to placentabenefits.info, “A very interesting adaptive theory is that consuming placenta may actually affect the mother’s immune system, by suppressing her body’s inclination to create antibodies as a response to antigens present in the baby’s blood… Placentophagia may actually cause a suppression of this response, allowing her to have successful subsequent pregnancies.”

 

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Disclaimer:  I am not a medical professional, and my intent with this article is not to tell you what to do.  Please discuss with your care provider and work together to make an informed decision regarding your care.