Education Resources Library

This page is in-progress. Much more to come! If you have questions for which you don’t see resources below, or would like to discuss personal approaches to any issues, please reach out.

Please note: the following resources are not intended as medical advice. Your body, your baby, and your birth are yours, and all decision-making power should be yours as well. In using the below information, Wellspring Birth asks that you consult your own body-knowledge and intuition, conduct any further research you would like, and consult any healthcare professionals you may choose prior to making childbearing and wellness decisions.

All blessings!

Prenatal Wellbeing, Testing, & Interventions

  • Managing your nourishment leading up to and during childbearing goes beyond intuitive eating. It means intentional, joyful self-sustenance, and a call not to depravation but to prioritization.

    You are growing an entire human, a placenta, 60% additional blood volume, amniotic fluid, a changed vascular system, increased fat stores in preparation for lactation, etc… and that means at least a 25lb weight gain for most folks. If weight and body-size has ever been a tricky thing for you, pregnancy is a wonderful time to reset your relationship with your body and food. Nourishment is the name.

    To feel vital, prevent disease, lower instances of birth defects, and recover quickly and well, nutrition is one of the most important things.

    In addition to personalized consults with me, the following are great places to start:

  • Contents: Cautions | Folate vs. Folic Acid | Iron, Anemia & Hemoglobin | Vitamin & Supplement Recommendations

    Cautions:

    Prenatal vitamins are an important part of nourishing your body and your baby, but multivitamins should be used with caution especially leading up to pregnancy and in the 1st trimester. Contrary to much basic advice, prenatal multivitamins containing iron supplementation, and folic acid (as opposed to folate) have been shown to cause nausea for the mother and potential toxicity for the embryo. This is one theoretical explanation for nausea and morning sickness with multivitamins - our bodies reject them, trying to protect our babies.

    Folate on its own helps baby’s brain, and is not dangerous, and you can also source prenatal multivitamins without iron, and add in iron selectively if and when it is actually needed. **To read this research for yourself: Source

    Folate vs. Folic Acid

    Folic acid and folate are not the same thing. Some medical websites and texts conflate the two; if you see a source referring to folate and folic acid interchangeably, that source is not reliable good information. Folate, found in leafy greens and other whole foods, is the naturally occurring bioavailable (able to be processed/used by our bodies) form, and will be present in good quality supplements. Folate is important prior to conception and in early pregnancy to support healthy neural tube (early brain) development. Folate may be taken independently of multivitamin supplementation (a folate pill on its own), and does not have the same risks as multivitamins in early pregnancy.

    Folic acid, on the other hand, is a cheaper, synthetically produced version which our bodies cannot process without first breaking it down, and some people cannot break it down efficiently or at all during pregnancy. It is present in many poor quality vitamins because it is less expensive for manufacturers, but it’s hard on your body and may or may not be helpful to baby at all. Stick with full, bioavailable folate.

    Iron, Anemia, and Hemoglobin

    First things first: mild anemia (hemoglobin/iron deficiency) in pregnancy is normal and healthy, and may even be a good adaptation to help your baby, but testing and diagnosis do not take this into account. Non-pregnant hemoglobin levels for women are considered normal between 11.6 an 16mg/dl, and these same standards are used in pregnancy without allowing room for physiologic changes.

    What’s going on: hemoglobin is the protein inside red blood cells (RBCs, also called erythrocytes) that uses iron to carry oxygen throughout the body. Anemia is diagnosed by measuring the level of hemoglobin in your blood, and returning a result of less than 11mg/dl. In pregnancy, mild anemia is normal and healthy: your total blood volume increases by about 60%, but the different parts of your blood do not increase equally. Your plasma level (the fluid part of your blood in which your blood cells live) increases more than your RBCs. This means that while the total amount of RBCs in your body increases significantly, the proportion of RBCs in your blood is lower relative to the amount of plasma. In other words, in pregnancy your hemoglobin is diluted - there is less in any given test amount than in non-pregnant blood, but more total in your body. So you may test as anemic because in a given measure of blood, a smaller percentage of that blood is RBC/hemoglobin, but if the test looked at the total amount of hemoglobin in your body, you’d be just fine.

    This is not to say anemia is always mild and healthy: it is possible to be truly anemic in pregnancy, and can have symptoms like severe PICA, but iron supplementation alone does not help with this. Iron supplementation treats the symptom, not the cause. Any iron supplement should be taken with caution, and if it makes you feel sick or nauseated, you may wish to discuss with a healthcare practitioner and/or stop taking it. To treat the cause, optimal pregnancy nutrition to help build healthy blood volume is the best way forward. Supplementation with iron can be used in harmony with nutrition (make sure you’re getting enough Vitamin C, which your body needs to absorb iron!), but see below for alternatives to iron supplements which help the body naturally build up its own iron. Truly building up healthy bloods is critically important for birth and postpartum healing.

    When using multivitamins is good:

    The caution period with multivitamins is 2 months (2 period cycles) before conception until full placenta functionality. Once you’ve reached your 2nd trimester, and your baby’s placenta is formed and doing its job, a full comprehensive good quality prenatal multivitamin once more becomes safe and recommended.

    Vitamin & Supplement Recommendations:

    Understanding the above cautions, I highly recommend Needed’s vitamins and supplements. They are women-owned, run, and developed, and are the most comprehensive prenatals on the market. Their ethical sourcing, and bioavailability of ingredients is unsurpassed. If you’re taking other prenatals, I’d recommend doing a comparison. I am not sponsored in any way by them. Discount Code: MAMASTENUTRITION

    **supplements do not replace good nutrition, but aid us when combined with a nourishing diet**

    • Fiber: Benefiber (easy to consume); Garden of Life (sprouted superfoods); foods like chia seeds, avocado, fibrous nuts & veggies

    • Protein powder: Collagen (Needed); Vegetarian (whey, Garden of Life); Vegan (Garden of Life)

    • Pre/Pro-biotics: SmidgeNeeded; whole foods like full-fat yoghurt, kefir, kombucha, sauerkraut, etc.!

    • Iron: Needed; Gaia Herbs Liquid Plant Iron

    • Natural iron- & blood-building help: Natures Sunshine Liquid Clorophil (favorite of traditional midwives for postpartum recovery)

    • Healthy Fats: Needed

    • Digestive Enzymes: Needed

    • Evidence on eating dates 1, 2, 3 (uncooked whole-food fruits) and Holistic Info. How to eat dates for the labor benefits: starting at 35-36 weeks, eat 2.5oz of dates daily; this is about 3 large medjool, or 6 small deglet noor dates every day until birth.

      • *Dates are high in healthy sugar, so care should be taken with Gestational Diabetes and with overall sugar consumption. Substitute dates for existing sugar sources in your diet, add them to protein smoothies, etc.

  • Pregnancy-related swelling (medically called edema or oedema), how to manage it, and when it should be taken quite seriously.

    Edema in pregnancy is a sign that your body is slowing down movement of fluid and lymph, but also a sign that it's expanding its collagen ratio, allowing your veins and arteries to swell with increased blood volume, and slowing down other circulatory processes to accommodate baby's needs. Swelling can be physiological and healthy, even if it's not fun. As one dear person said 2-weeks postpartum: "Oh my GOSH I have my feet back!!! I missed having ankles."

    When it's serious: sometimes swelling can be a beginning sign of other things going wrong. Swelling on its own is not pathological. Even extreme swelling or varicose veins can be a comfort issue but is not always not a pregnancy safety issue. However, if the swelling is accompanied by a combination of the following -- heart palpitations, dizziness, headache, consistently elevated blood pressure (clinically above 140/90 and sustained for >1 hour, though this varies person-to-person and merits more discussion), protein in your urine, mental confusion, pain in the Upper Right Quadrant of your abdomen (liver distress), etc. -- these symptoms together might be a sign that your body is truly struggling to keep up with the demands of pregnancy and that greater medical care is needed. Swelling alongside these other symptoms can potentially be signs of preeclampsia, ICP (intrahepatic cholestasis of pregnancy - when your liver struggles to process toxins so they instead enter your bloodstream), HELLP (like ICP but with further blood and platelet implications), etc. Swelling does not necessarily mean you have these issues, but it is something to keep tabs on with your midwifery/OGBYN team, as they can test you for other measurable symptoms like blood pressure and protein in the urine, set your mind at ease, and intervene medically if the need should arise.

    For hemorrhoids or varicose veins, talk with your health care provider about more area-specific approaches and medication/compression options.

    If the swelling is on its own (not part of a larger problem - physiological but unpleasant swelling) -

    Management includes:

    • hydrate, hydrate, hydrate! Counterintuitively, one of the best ways to help your body get rid of excess fluid is to make sure it has enough fluid running through the system to be able to clean itself out efficiently and with ease. Drink more fluids to get rid of unwanted fluid overload. Yup, sounds backwards, but it's true!!

      • have a water bottle/glass of water next to you always. Drink consistently.

      • A few times a day, that should be electrolyte water: find your favorite electrolytes and drink as much as feels and tastes good

    • get a good quality warm-mist humidifier for your bedroom. Cold mist isn't sterile, and can do odd things to your room surfaces. Make sure it goes all night - if it's a percentage-based (as opposed to on/off), just set the requested humidity to 90% (which is impossible to reach), and sleep comfortably in these cold/dry months.

    • epsom salts (magnesium salts) baths can help your body fluid-regulate (add some lovely oils and scents and relax!)

    • lymphatic massage: you can do this to yourself or have a partner help. At least once a day is a lovely way to care for yourself, and give your limbs some relief from the pressure. This video shows how.

    • Keep moving! your body can't regulate fluid if you're stagnant too.

      • Yoga, regular walks, don't stay in one position for too long. Aside from sleeping, try to move position at least once every 30mins or so.

      • Take stretch breaks! Take lie down breaks regularly as you're able. Elevate your legs for 15mins at a time regularly,

      • 20-30mins walking per day, enough to get the heart rate up but not jumping. This helps with blood pressure and a whole host of other things.

    • nourishment: making sure you're eating as nutrient-dense as possible. In addition to good food and supplements:

      • NORA tea, 2 cups per day. You can make your own herbal blend and add things like dandelion (or hire me to make one for you), or this is a good one ready to go: https://earthmamaorganics.com/products/organic-third-trimester-tea

      • Note that these teas don't steep like normal tea, but require a full herbal infusion: boil water, then steep for 15mins.

    • Compression: get yourself some powerful, good quality compression socks and/or stockings. If your wrists/fingers are swollen, try compression gloves! They have pretty cute versions now, and these will be extremely helpful as you go deeper into 3rd trimester and for postpartum. Some good options:

    Swelling is super common with pregnancy, especially as you get late into the game. It's bothersome, but can be physiological and normal, and can be managed if not completely eliminated by taking good care of yourself. Keep in touch with your midwife team and keep them updated so that you can know that your edema is isolated, and any larger issues get caught early and safely.

  • While managing blood sugar and ensuring good nourishment during pregnancy is of great importance, the way the US medical system tests for and intervenes with Gestational Diabetes is not evidence based. Lower insulin and more available glucose may be physiological for you, as it is for many folks in pregnancy. Intervention for its own sake and testing which does not improve outcomes ought to be taken seriously.

    However, true macrosomic babies struggle, and your body and health will struggle if things are out of balance. If you or your Health Care Provider is concerned about your Blood Gucose Levels (BGLs), read the below, call on your own body-knowledge and intuition, and decide how you want to proceed.

  • Still to come!

  • Still to come! Reach out if you’d like individually curated resources.

  • Group B Strep, or Beta Streptococcus is a type of gut bacteria which can infect and colonize the vagina. While this is usually harmless in adults, there is risk to newborns exposed to GBS during birth. However, the screening, research, and risks of GBS to your baby vs risks of treatment should be considered thoroughly.

    The choice is between the risks of GBS-illness, and the risks of antibiotics and associated hospital intervention policies to your birth and your newborn.

    Risk factors for GBS can be boiled down to unhealthy vaginal microbiome, and any lifestyle situations that interfere with the vaginal microbiome such as: multiple sexual partners; frequent oral sex; high processed food or sugar consumption; diabetes; tampon use; smoking/vaping; poor hygeine; history of frequent or chronic vaginal infection or disease; insufficient nutrition and vitamin C intake. Prevention can include limiting or eliminating the above factors.

    Info on Testing & Routine Antibiotic Treatment

    • GBS is routinely prenatally screened for in the US between 36 and 38 weeks gestation. It is a transient infection, meaning it can come and go as your vaginal microbiome and hormones shift, but this is not taken into account in testing protocols: if you test positive or negative, current practice assumes this is your status for the remainder of your pregnancy. The recommended treatment if you test positive is hospital birth with IV antibiotics throughout labor, or antibiotic injections every 4 hours during labor. If your waters break prior to labor (PROM), this protocol also includes induction. Beta Strep is thought to have infectious potential as soon as the amniotic sack is ruptured, and that increased time with open waters increases infection risk. Note: this is not an evidence-based conclusion, but it is the thinking that informs medical practice.

      • 20% of people who test positive are actually negative at the time of birth, and 10-20% of people who test negative will be positive at birth. Importantly, 2/3rds of all babies who become seriously ill are born to mothers who tested negative, and therefore the babies are not being monitored as carefully.

      • If you are recommended induction for being GBS+, and your waters are not broken, know this is not medically indicated or evidence-based at all. GBS on its own when your waters are intact is never a reason for induction.

    • A baby has a very low chance of becoming seriously ill from GBS. Some statistics: if you are pregnant, you have a 10-25% chance of having GBS; if you test positive, your baby has a 0.25% (1 in 400) chance of contracting GBS during birth; if baby is colonized by GBS bacteria, there is a 4-5% chance of serious infection, and if your baby develops a serious infection there is a 1-2% chance of death**. Or positively: with no treatment, your baby has at least a 99.75% chance of being just fine.

      • Note: the above is true for full-term babies. If your baby is born prematurely, before 37 weeks, the risk of GBS doing them harm is much greater.

    • You have the right to decline the GBS screening test entirely. If your birth care team is not hospital-based, they may have legal restrictions in place on how/if they can continue care should you decline testing - discuss with your care team and make sure you have a plan in place. In a hospital setting, if you go to the ER during birth and have not been tested, they may try to proceed as if you are default-positive. If you decline testing, be prepared to stand firm in this decision and know your rights.

    • Routine IV antibiotics for GBS during birth does not totally eliminate the risk of illness or death, but does reduce the chance from 1.7 in 1000 GBS+ babies to 0.2 in 1000.

    • Risks of Antibiotics/Active Management: If you have antibiotics during labor for GBS, this necessarily has real implications for your baby’s microbiome, baby’s immune and autoimmune system, and their longterm health. See the Resource Section for extensive discussion, and the Microbirth film. IVs during labor will also artificially inflate your baby’s birth weight (giving your baby extra water-weight, meaning they will necessarily lose a higher percentage of their birth weight than they naturally would). If you consent to an IV for any reason, be prepared to advocate strongly to establish breastfeeding and avoid supplementation for initial weight loss alone, taking into account your child’s overall wellbeing - muscle tone, engagement, feeding, diapers - and not just weight loss percentage.

    Alternatives to Antibiotics in Labor

    • Natural GBS Prevention & Management: nutrition, probiotics, and specific natural remedies can be very effective in reducing GBS colonization rates to sub-infectious levels. This means that while you may still have the bacteria in your vagina, if treated successfully with natural methods there would be such a small amount of the GBS present that it would not infect your baby. Consider using these natural methods prior to your first GBS screening test. If you have already tested positive, using these methods may allow you to retest negative later, and maintain a sub-infectious healthy vaginal microbiome for your birth. This may be combined with expectant management (next bullet point). See the resource section below for further info.

    • Expectant Management: the “no interventions, wait, and watch carefully” option. If you test GBS positive, your baby has at least a 99.75% chance of being totally fine without intervention. Combined with natural infection prevention like above, you are extremely unlikely to transmit an infection to baby. But what if they do get sick? If your baby were to be in that rare group of GBS+ births that do result in illness, more than 90% of babies who do become ill from GBS will show clear signs of illness within the first 48 hours after birth. Given the extremely low likelihood of your baby becoming ill, instead of receiving antibiotics you may choose to work with your health care team to observe baby carefully in the first 24-48hrs for any signs of infection, and treat promptly if such signs do occur. If you plan to go this route, discuss ahead of time with your healthcare team so everyone is on board.

      **the serious illness/mortality outcome percentages above do not take into account, organized, proactive expectant management in which onset of illness is caught promptly and handled by a competent healthcare team. We have no data on outcomes from parents who chose this route, but may assert that it will be at least as good as the percentage data above if not much better.

    Resources

    Film: Microbirth (dives into the importance of the microbiome at birth for lifelong health)

    Theodosiou et al, “Microbiotoxicity”

    Sarkar et. al., Microbiota and Longterm Disease

    Dhariwala, Sharschmidt. Baby’s Skin Bacteria Imprinting

    Sara Wickham, GBS Explained

    Sara Wickham, “GBS Screening, The Evidence”

    Down To Birth Podcast: GBS Episode

    Rachel Reed, “The Human Microbiome”

    Evidence Based Birth, “Evidence on Group B Strep in Pregnancy”

    Schuchat, A. “Epidemiology of group B streptococcal disease in the United States: shifting paradigms.”

    CDC, “Clinical Information About Group B Strep”

    Placenta Network, “How to Prevent and Treat a Group B strep vaginal infection Naturally” - I’d add to this topical vulva use of raw organic coconut oil and unsweetened plain yoghurt are also supportive of a regulated vaginal microbiome (soothing for yeast infections too!)

    Wellness Mama, “How I Avoided GBS Naturally”

    Gentle Birth, Discussion of GBS, Antibiotics & Natural Treatment

    Cochrane Library, GBS Review

  • Still to come! Reach out if you’d like individually curated resources.

  • Still to come! Reach out if you’d like individually curated resources.

  • Ultrasound imaging, or sonography, has been part of routine medicalized prenatal care for over 30 years. You’d think something so widely used would be proven harmless, and would improve outcomes for babies and families, yes? …Nope.

    The reality is this:

    1) There is no evidence proving ultrasounds are safe. (i.e. no experimental research evidence)

    2) There isevidence proving that ultrasounds during pregnancy do not improve outcomes whatsover for morbidity or mortality.

    Discussion of Testing History

    Ultrasounds are extremely inaccurate in diagnosing problems; in fact, the only thing that ultrasounds statistically result in is increased intervention without better outcomes.

    The last human research studies done to establish safety were from the 1980s and early 1990s, testing ultrasound strengths much weaker than those used today. Two types of studies were done: animal studies showed significant potential harm to the fetus, especially in early gestation; and broad, low-quality human studies during which the control and experimental groups were badly mixed rendering their results meaningless. In 1991, all US efforts at researching safety via human studies were stopped. In other countries, studies continued to demonstrate potential harm. Shortly thereafter ultrasound technology strength increased 700%. Ultrasound manufacturers actually recommend that prenatal ultrasound only be used if truly medically necessary, as they can do more harm than good. See the Resources section for further info.

    Prenatal ultrasonography now falls into a category with so much other obstetric medicine: despite not being based in evidence, and because it is accepted practice, it would have to be proven unsafe for us to stop routine use. In this paradigm, running quality trials to truly investigate safety is considered unethical. Between this and the money hospitals make billing insurance for ultrasonography, we are very unlikely ever to see good quality human studies.

    Risks of Ultrasounds

    Setting aside the fact that wedo not know if ultrasounds are safe (and animal studies indicate they may not be), the other main risk from prenatal ultrasound is increased intervention, followed by increased stress for the mother. Ultrasounds are not good at predicting problems or accurately diagnosing issues, and do not improve outcomes.

    Obstetric medicine uses ultrasounds to diagnose everything from big baby, to low amniotic fluid volume, to fetal echogenic bowel… but ultrasound results are inaccurate, with high error margins. Erring on the side of caution, and ignoring evidence to the contrary, many healthcare practitioners will use these tests to recommend changes to your birth plan. These test results and the pressure to accept interventions can be extremely stressful, and stress in and of itself is a risk factor in pregnancy.

    Remember: policy means the hospital must offer, not that you must accept. If you decide to have ultrasounds during your pregnancy, be prepared to advocate for yourself if interventions are offered. See if other tests can be used to confirm a diagnosis. Check in with your own body and your baby. Finally, get a second (or third!) opinion - not every ultrasound tech is equal!

    Benefits of Ultrasounds

    Ultrasonography is a tool that can help you navigate personal pivot-points in your pregnancy.

    This is especially true regarding congenital abnormalities: if you would make different decisions, plan differently, or pursue different outcomes depending on the presence or lack of fetal abnormality, ultrasounds may be a good option for you.

    You may wish to opt out of routine screening, and consider having only one or both of the following:

    • The 10-week scan looks at neural tube development, and can help detect chromosomal disorders like down syndrome and other trisomies.** You can also find out the sex, if you choose.

    • The 20-week scan looks for anatomical abnormalities. This scan can diagnose - but not change the outcome medically for - potential birth defects, structural malformations, and other health issues. If an issue is found, further tracking can be planned, or other tests scheduled to monitor the situation.

    If you feel that knowing results like these in advance would help you make plans, get resources lined up, prepare yourself mentally, etc., this may be a good choice for you.

    Some caution regarding 3-D and 4-D ultrasounds: while they can give you cute keepsake pictures, these use a particularly strong and long-lasting form of ultrasound and have no medical benefit and no good quality safety testing whatsoever, so use your own wisdom here.

    Alternatives

    The two main alternatives to ultrasound imaging are 1) Decline all or some ultrasounds, and 2) prenatal cell-free DNA screening.

    1) Opting out of ultrasounds during pregnancy: this is your complete right as a parent, and is entirely your decision. This does not mean you can’t have any other testing, or that there are no other ways of checking in with your body and baby. You can also choose to have one or more specific ultrasounds, but decline the routine.

    2) NIPT Test, or Prenatal Cell-Free DNA Screening: ** everything the 10-week scan can tell you, this test can tell you too and with better accuracy. It is completely non-invasive for baby, taking some of your blood, separating out your baby’s blood (some of which passes through the placenta and circulates through your veins!), and doing a thorough DNA test to look for any issues, tell the biological sex, etc.. There are no risks to this test beyond the normal risks of a blood draw. Note: this is not a routine test, so you may have to ask for it.

    Regarding the 20-week scan and finding out anatomy abnormalities ahead of time: the alternative here is simply not to know until baby is born. This is how our matrilineage would have experienced birth: the emotions, difficulties and joys arrive at birth, and beforehand is just hope and love. Consider whether knowing about problems before birth would help you, or if it would cause you unnecessary stress and pain. That is a decision only you can make.

    Resources

    Medline.Gov “Prenatal Cell-Free DNA Screening”

    Dr. Sarah Buckley, “Ultrasound Scans Cause for Concern”

    Sarah Pope, MGA, “High Risks of Prenatal Ultrasound”

    Abramowicz, J. “Benefits and risks of ultrasound in pregnancy”

    NIHR, “Universal ultrasound in late pregnancy did not reduce serious harms to babies”

    Newham et. al., “Effects of frequent ultrasound during pregnancy: a randomised controlled trial”

    Robyn Horsager-Boehrer, M.D., “Why to avoid ‘keepsake’ 3-D and 4-D ultrasounds”

    Torloni et. al., “Safety of ultrasonography in pregnancy: WHO systematic review of the literature and meta-analysis”

    Rachel Reed PhD, “Testing Testing…”

    Rachel Reed, PhD, “Big Babies: the risk of care provider fear”

    Milner & Arezina, “The accuracy of ultrasound estimation of fetal weight in comparison to birth weight: A systematic review”

    Bucher & Schmidt, “Does routine ultrasound scanning improve outcome in pregnancy? Meta-analysis of various outcome measures.”

    Hedrick & Hykes, “Biologic Effects of Ultrasound: III In Vitro and Animal Studies”