Ask a Doula
Q: My latest blood tests showed I have mild pregnancy induced anemia. I already have issues with constipation, so can you recommend an iron supplement that doesn’t make this worse?
A: There is a good article in the Journal of Clinical Nutrition that shows that a low dose iron supplement is effective in steering off Iron Deficient Anemia without the gastrointestinal side effects (constipation etc). I think that a lot of the constipation comes from too much iron – so keeping it at a 20mg dosage might be the key (and not so much which brand of iron is best). You can probably go store brand and be fine. Just double check what you are already taking in your prenatal vitamins, or do an iron free prenatal and add on an iron supplement. Also confirm with your care provider if this is in line with her plan for your medical care.
http://www.ajcn.org/cgi/content/abstract/78/1/145
I have seem some shout-outs for Floradix, it’s a liquid formula at the natural health stores and probably Whole Foods. If constipation on a low dose regime is still problematic you might consider this option and talk to your doctor about it. It is pricey though.
There was also a recent journal article in the American Journal of Obstetrics that cautioned against too much iron for another reason, getstational diabetes.
http://www.ajog.org/article/S0002-9378%2809%2900443-8/abstract
An interesting hypothesis, so if you have diabetes in your family history, or high early glucose levels, you might talk to your doctor about these findings too. Of course you’ll know more at your glucose test around 28 weeks on that issue, but I think it’s good to have all the facts.
-Ame
A: I can personally attest to effectiveness of floradix. That’s what my midwife recommended during the end of my pregnancy and it helped to raise my iron fairly quickly without any stomach irritation. Nettles as well as beans, nuts and seeds, red meats, beet juice, kale or other hearty green, and black strap molasses are really good sources of iron. Vitamin C is important for the absorption of iron so if you’re cooking up some kale squeeze some lemon on it. Yum… is it time for a midnight snack
If you are unfamiliar with nettles, here is some additional info. “Nettle has astringent, expectorant, galactagogue (milk producing), tonic, anti-inflammatory, hemostatic, and diuretic properties. The plant is rich in chlorophyll, and a good source of beta carotene; vitamins A, C, and E; tannins; iron; calcium; phosphates; and various other minerals, especially silica. The active ingredients include water-soluble polysaccharides that stimulate the immune system, and large protein-sugar molecules known as lectins. The entire plant may be used in various medicinal preparations.” altmd.com
Nettles by themselves can taste a bit “grassy” so I would recommend mixing it with a bit of red raspberry and mint. Then steep the leaves about 15 min add a few drops of honey or agave nectar and put over ice. During my pregnancy, I would make a big batch in a quart jar, pop it in the fridge and drink on it though the day. If you don’t want to look for all these things and put them together yourself, Texas Medicinals in Austin has a spectacular blend that is local and organic. Ginger Web is the Herbalist and She is great. I buy from her in bulk to give to clients. Her Strong Mama Tea has red raspberry leaf, nettles, dandelion leaf, alfalfa, oatstraw, and spearmint. It’s a little more expensive than rounding it up yourself but you get what you pay for.
-Janet
Q: I’m past my due date. Any suggestions how to get this show on the road?
A: Yes! Acupressure points on hands and feet can’t hurt since you’re term. Go get a pedicure too so your foot look good in those pushing stirrups. Do some hands and knees (cat cow) yoga work to flip that baby over (although most babies will flip on their own as they descend through the birth canal – but it’s can’t hurt – pushing sunny side is never fun). Melissa Light at East West in Austin does acupuncture for labor induction – and a lot of doulas recommend her – if you get desperate. Lots of walking every day. Sex (semen helps to some degree with cervical dilation). Some new research is coming out on the contractile benefits of Castor Oil – so the old wives tales may be true, although not very tasty and usually with colon cleaning side effects.
-Ame
A: One thing that I’ve seen work for several mamas that wanted to get their labor going a little faster is using a breast pump for 20 minutes every other hour.
-Amy
Q: Do you bring a birth ball to the labor and delivery room?
A: Yes – as doulas we will bring all the equipment to your birth, including birth ball, rebozo, massage tools, massage and aromatherapy oil, hot and cold packs, and other surprises in our bags of tricks.
-Ame
Q: I’m concerned about episiotomy and tearing. Anything I can do to prevent this?
A: A great article that came out in AJOG (American Journal of Obstetrics and Gynecology – the one I subscribe to) has a laundry list of all of the ways different natural and medical interventions affect the course of labor and delivery. The three that receive an “A” rating or the recommendation of the researchers based on evidence are 1. Doula; 2. Pushing in an upright position; and 3. Perineal massage. Starting perineal massage from 34 weeks, as well as doing it during labor (which nurses and doctors routinely do) will help prevent tears and episiotimies by helping the muscles naturally stretch. Here is a link to the full text article:
http://download.journals.elsevierhealth.com/pdfs/journals/0002-9378/PIIS0002937808007758.pdf
And here is a cut and paste on how to do perneal massage – so have at it!
Here are great step-by-step instructions found in the book, Pregnancy, Childbirth and the Newborn, by Simkin, Whalley and Kepplar.
Perineal massage should be started at 34 weeks of pregnancy or 6 weeks before your due date.
How to do Perineal Massage
Perineal massage can be done by you or your sexual partner. The first few times, take a mirror and look at your perineum so you know what you are doing. Be sure your fingernails are short. If you or your partner has rough skin, it might be more comfortable to wear disposable rubber gloves. Wash your hands before beginning.
Make yourself comfortable, in a semi-sitting position, squatting against a wall, sitting on the toilet, or standing with one foot up on the edge of the tub or a chair. Some women may find it comfortable to do perineal massage in the shower.
MASSAGE:
1. Lubricate your fingers well with oil or water-soluble jelly. Some people recommend wheat germ oil, available at health food stores, because of its high vitamin E content, but other vegetable oils, such as olive oil or water-based lubricants such as K-Y jelly can also be used. Do not use mineral oil or petroleum jelly. Wash your hands before dipping into the lubricant again.
2. Rub enough oil or jelly into the perineum to allow your fingers to move smoothly over the tissue and lower vaginal wall.
3. If you are doing the massage yourself, it is probably easiest to use your thumb. Your partner can use his index fingers. Put the fingers or thumb well inside the vagina (up to the second knuckle); move them upward along the sides of the vagina in a rhythmic U or sling-type movement. This movement will stretch the vaginal tissue (mucosa), the muscles surrounding the vagina, and the skin of the perineum. You can also massage by rubbing the skin of the perineum between the thumb and forefinger (thumb on the inside, finger on the outside or vice versa). In the beginning, you will feel tight, but with time and practice, the tissue will relax and stretch.
4. Concentrate on relaxing your muscles as you apply pressure. As you become comfortable massaging, increase the pressure just enough to make the perineum begin to sting from the stretching. (This same stinging sensation occurs as the baby’s head is being born at the end of the pushing stage.)
5. It is recommended to do this massage for 5-10 minutes daily from the 34th or 35th week of pregnancy until labor. Check with your caregiver if you have questions.
-Ame
