I’ve experienced sexual trauma and am terrified at the thought of giving birth vaginally. Is it horrible that I want to ask for a cesarean birth?

Excerpt from Asking for a Pregnant Friend: 101 Answers to Questions Women Are Too Embarrassed to Ask about Pregnancy, Childbirth, and Motherhood

It’s not horrible at all. You should have whatever type of birth you think you’d be most comfortable with. The combination of giving your body up to another human during pregnancy, being touched in a clinical manner in the same areas the abuse likely took place, and potentially feeling a loss of control in medical settings can equal a birth experience ripe with triggers and anxiety. It can also bring up fear of receiving treatment from a male doctor, nurse, or ultrasound tech. It’s a complex path to navigate.

Adding to this complexity is the lack of energy many women have for managing their anxiety during pregnancy and childbirth. Because the coping skills developed after surviving sexual trauma often require significant strength to implement, the energy that pregnancy and childbirth siphon away can leave a woman feeling vulnerable to triggers and all the resulting emotions and physical responses. One survivor I worked with said pregnancy made her feel like she was on an out-of-control rollercoaster of joy, fear, sadness, excitement, anxiety, and anger — until she took the steps listed below.

What to do

Take it one step at a time. Even women who haven’t experienced sexual trauma can find pregnancy and childbirth overwhelming. When you’re

managing the added weight of being a survivor, the process can feel defeating. But if you focus on one empowered action at a time, you can navigate your way to a space of calm and trust that can carry you through a positive birth experience. Here are some ideas to get you started:

Rest. This is always important, but it’s especially so when navigating the added anxiety of past sexual trauma.  

Find a care provider you trust implicitly, then share your story. After you’ve interviewed various care providers and have found one who makes you feel safe, tell them whatever aspects of your story you’re comfortable sharing. (It may take many visits before you trust them enough to share this information.) They should then offer clear ideas on how they’ll adapt their care to honor your needs. They should also be open to hearing how you want to be cared for. It’s important that this feel like a collaborative relationship, and not one where they’re the authority figure and you’re the passive recipient of what they deem “right” for your body. They should involve you in every decision, continually reassuring you that you’re in the position of control — they’re just there for guidance and to provide the support you deem necessary. If they don’t make you feel this way, I urge you to find a new care provider.

Request female care providers. If you think being touched by men will trigger you, add to your birth preferences that you would like to be cared for only by women, and discuss this preference with your primary care provider. While this might not always be possible (for example, there might only be a male anesthesiologist available if you’re getting an epidural), identifying this preference gives you a better chance of creating an environment that facilitates optimal comfort.

Ask for comprehensive communication from care providers. Survivors I’ve supported felt anxious during prenatal visits and childbirth because they never knew when they would be touched. Some were so uncomfortable with surprise touch that they dissociated from their bodies and felt unconnected to their pregnancy and birth experiences. You can prevent this by telling all your care providers (e.g., doctor or midwife, ultrasound techs, nurses, assistant midwives, etc.) that you need them to inform you before touching you, and to fully explain what they’re doing and why.

Speak up when you feel uncomfortable. Even when you make it clear you want thorough communication about required touch and you want that touch to be gentle, you might still get a care provider who isn’t respectful of your requests. If that happens, don’t be afraid to speak up, and if possible, ask for a different care provider.

You might also have the experience of someone fully honoring your needs, yet still making you feel uncomfortable. If this happens, you have every right to ask them to cease touching you until you feel comfortable resuming.

Make it clear that it’s imperative you don’t lose your voice during the birth experience. I’ve attended the births of survivors who had care providers who made them feel safe…until labor and delivery. These care providers assured the women that they wouldn’t be pressured into decisions they weren’t comfortable with and they would be treated with the same level of respect they’d received during pregnancy. But then labor began, and the promises dissolved. This resulted in the women feeling like they were no longer in control of their birth — like they were being silenced. This doesn’t have to happen to you. See “Essential Tips for the Journey” on page xx for more information on how to maintain your voice during birth.

The importance of speaking up throughout childbirth is reinforced by an article published in BMC Pregnancy Childbirth that found (not surprisingly) that the most effective guide on how to support a survivor of sexual abuse through childbirth is the birthing woman herself.

Ask yourself whether a vaginal or a cesarean birth seems more triggering. Ask your care provider or childbirth preparation educator to walk you through what you can typically expect during a vaginal and a cesarean birth. As you hear about the components of each experience, take note of what raises your red flags. For example, I worked with a survivor who didn’t like the idea of having an oxygen mask on her face during a C-section, while another was terrified of the idea of a vaginal tear. While it’s impossible to know exactly how you’ll handle a vaginal or cesarean birth, this mental mapping can help you determine what type of birth could be best for your unique needs.

Consider hiring a doula. Regardless of the type of birth you select, a doula provides an additional layer of support that can soothe many of your fears and anxieties before, during, and after birth. If you’d like a doula, do as you did with care providers and interview many candidates until you find one you trust enough to share your story with. From there, be clear about the type of support you want, and what you anticipate being difficult. For example, if you’ve selected a C-section but are nervous about feeling out of control while under the influence of opioids, brainstorm ways your doula can create a safe container for you.

Think about the birth positions that might trigger you. Certain positions can bring up memories of abuse, which is why it’s important to learn the most common birth positions, and let your care providers know if there are any you do not want to be in.

Think about phrases that might trigger you. Much like the birth positions, there might be phrases you associate with abuse. For example, if phrases like “Just relax” or “Don’t worry, it will be over soon” have negative connotations for you, tell your care providers not to use them, and add these requests to your birth preferences.

Read Penny Simkin’s book When Survivors Give Birth. This extraordinary book dives into the complexities of giving birth while managing the PTSD caused by sexual trauma.

Select a childbirth preparation class that provides tools for managing fear and anxiety. While many classes provide excellent tools for pain relief, few go deep into how to manage the fear and anxiety that can arise during the journey to and through childbirth. In my biased opinion, the HypnoBirthing and Birthing from Within modalities provide the most effective techniques for this emotional support. You can supplement these classes with my online course on Udemy, “Childbirth Preparation: A Complete Guide for Pregnant Women,” which provides over fifteen relaxation recordings and an entire section on fear release. It can be found here: http://www.udemy.com/course/ childbirth-preparation-a-complete-guide-for-pregnant-women.

Create a list of your go-to relaxation tools. If you’re triggered during birth, it will be helpful to have a list of calming techniques. To create this list, practice the techniques offered in your childbirth preparation class, and note which ones are most effective. Provide this list to your birth companions, and explain how they can lead you through the techniques.
Help your birth companions pull you out of dissociation. Dissociation — feeling disconnected from your body and the here and now — is something many survivors experience. It’s a common coping mechanism, and it could occur during birth if you’re retraumatized. However, your birth companions can pull you out of it with a few simple techniques.

First, it’s important for your birth companions to understand the signals of dissociation. For example, your eyes might “glaze over,” or you could start moving or responding in a spaced-out manner. Essentially, you start to act really different — like you’ve checked out. Discuss this with your birth companions before birth, and ask the person you feel safest with to do the following if they think you’ve dissociated:

  • Ask everyone to leave the room.
  • Hold eye contact with you. If your eyes are closed, they can snap their fingers or say your name in a strong voice. They can then instruct you to open your eyes if you don’t open them during the initial prompts.
  • Figure out a phrase you want them to use to help you acknowledge what’s happening. For example, they could say, “It seems like you went somewhere else for a while. You’re safe to come back to the room.”
  • Once you seem to be coming back into your body, they can ask you where you are and what you’re doing. They can also ask you to explain what your five senses are experiencing.
  • Finally, they can strengthen your connection to your body and the present moment by giving you an essential oil to smell, placing a cool compress on your forehead, or pressing their hands down on your shoulders.

Take heart that you could have a new relationship with your body after childbirth. While it’s not a given for all survivors, many report having a transformed relationship with their body after birthing their baby. The experience might help you to see your body in a new light (it’s a vessel for new life!) and connect with it in ways that evoke feelings of pride, gentleness, and nurturing. Birth certainly won’t erase the atrocities you experienced, but the experience can allow you to have a fresh beginning with your body.

Note: If you feel that pregnancy and preparing for childbirth could bring up intense emotions and memories, consider working with a trauma therapist.

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I’m paralyzed by the thought of birthing in a hospital. But I’m also uncomfortable with a home birth. What should I do?

Excerpt from Asking for a Pregnant Friend: 101 Answers to Questions Women Are Too Embarrassed to Ask about Pregnancy, Childbirth, and Motherhood

I would like to say that the answer is as simple as choosing a birth center (and it might be!). But there’s probably more to this question because it’s really about fear, and choosing a birth center won’t dissolve the underlying fears you may have. So let’s start by exploring why some women are afraid of hospital births.

For many of us, the hospital is associated with injury and illness. It’s the place you go when something is wrong and you need to be poked and prodded. That’s enough to make anyone nervous. In addition, almost every depiction most people have seen of birth was from mainstream media: panicked women being rushed into a hospital, hooked up to machines and an IV, and then screaming at their partner (comedies), or almost dying (dramas). Those are the messages our minds have received about hospital birth. For some women, these images translate into, “I have to birth in a hospital because it’s the only safe place.” For others, they trigger the fight-flight-or-freeze response, making the hospital a suboptimal place for them to birth.

And now for the fear of home birth. Going back to the messages we’ve received from mainstream media, the rare home births shown in prominent shows or movies almost always end in an emergency transfer to a hospital, and the mother regretting her decision to try a home birth. In addition, many people have the misconception that a home birth is dangerous and irresponsible. But the reality is, if a certified midwife who has confirmed you’re a good candidate for a home birth is caring for you, this environment is almost always incredibly safe. An article published in Journal of Midwifery & Women’s Health reported that planned home births for low-risk women result in low rates of interventions, without an increase in adverse outcomes for mothers and babies. The key term in that finding is low risk — if you have special circumstances that could require medical care to keep you and baby safe, a hospital birth is likely the best choice. But if you and baby are all good, a home birth is a viable option.

Taking all this into consideration, it’s easy to see why many women have a tricky time deciding where to birth. However, there is a way through.

What to do

The following exercises and considerations can help you discover what you’re actually afraid of, process the resulting information in a way that helps you make a birthing-location decision you feel good about, and acquire tools to reinforce comfort in your decision:

Break down your fears. Figuring out the makeup of our fears often makes them more manageable.

  • To do this, write Hospital and Home Birth on the top of a page.

Then, under each, write everything about that birthing environment you’re afraid of. Get specific. For example, under Hospital you might write, “The IV. The sterile smell. Infection. A mean nurse. The impersonal energy. Pressure to have invasive interventions.” For Home Birth you might list, “Not being able to get quick care if surgery is needed. The midwife not knowing What to do in an emergency situation. Having to clean up the mess. The guilt if anything goes wrong.”

  • Next, talk to a doctor you trust about your list of fears about a hospital birth. Have them give you the skinny on the object of each of your fears. For example, you can ask what’s the likelihood that it will occur, and if there’s anything you can do to prevent it.
  • Then, talk to a home birth midwife about your list of home-birthing fears.
  • After you’ve had these discussions, sit with the information as you flow through the following suggestions.

Consider a birth center delivery. After you’ve explored your fears, visit a few birth centers. In each one, tune into how the environment and care providers make you feel. Does it seem like a happy medium? Does it make you lean toward a hospital or home birth? Or are fresh fears coming up?

If big doubts still come up, the base of your fears might be more about the process of birth than the environment where you’ll be birthing. In this case, review question 44, about the fear of death during childbirth. This question breaks down the deeper fears of childbirth and provides tools for working through them. After you’ve worked these tools, you’ll likely have more clarity about the birthing environment that’s right for you.

Interview OB-GYNs and midwives. A big factor in how comfortable women are in a birth environment is how safe they feel with their care provider. So I recommend meeting a handful of OBs and midwives (both birth center and home birth midwives) to see if you find some- one who makes you feel heard and protected. This relationship will likely inform where you want to give birth.

Listen to this meditation. The meditation recording at the following link helps you process the information you’ve gathered by walking you through visualizations of what it might be like to birth in each space: yourserenelife.wordpress.com/ideal-birth-space/.

Watch reassuring birth videos. If you Google the terms “HypnoBirthing home birth videos,” “positive home birth videos,” and “Hypno- Birthing hospital birth videos,” you’ll find numerous videos showing home birth and hospital birth in a gentle, positive light. It’s easy for me to tell you how safe birth can be in both settings, but actually seeing women soundly birthing in these environments can go a long way in convincing you.

In addition, look up the video Birth as We Know It — Educational Version on YouTube, as it also shows peaceful births. (Some of the births are a bit unorthodox, but many are really powerful — there’s even an orgasmic birth!)

Know that it’s okay if you’re not totally comfortable in your birthing environment of choice. Regardless of where you choose to give birth, there will likely still be some nervousness when you’re in that space, as it’s where you’ll be going through an intense life change. If you’ve gone through all the steps above and thoughtfully chosen the birth space that feels best, these nerves likely have more to do with what will happen in that environment than the environment itself.

Avoid letting your trepidation spin into intense anxiety by continuously reminding yourself that it’s okay to feel nervous — I can almost guarantee that every birthing woman who came before you felt the same way. And remember that nervousness can absolutely live in harmony with excitement and courage.

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Why am I so afraid I’ll die during childbirth?

Excerpt from Asking for a Pregnant Friend: 101 Answers to Questions Women Are Too Embarrassed to Ask about Pregnancy, Childbirth, and Motherhood

You probably feel that way because a culture of fear has permeated childbirth. It bloomed when childbirth actually was a dangerous endeavor — when women weren’t able to get quality care if a special circumstance came up, when doctors didn’t know they needed to wash their hands between treating patients. Those women had good reason to fear death. But many of the risks those women faced are gone, and modern medical advances have made childbirth an incredibly safe experience. There is now effective protocol for even the most dangerous circumstances. And the great thing is, most women don’t even need to receive medical care during childbirth, they just need a trained care provider observing them in case intervention is needed.

So now that we’re covered for worst-case scenarios, we can relax into childbirth, right? We can let go of the fear of death. But that’s easier said than done. Our conscious minds can know that death is a highly unlikely outcome of childbirth, but the subconscious mind still holds onto the belief. There are a few reasons for that. Media is one of them. Think about every depiction of childbirth you’ve seen in mainstream media. I can almost guarantee those images consisted of angry women screaming in pain. Each time you saw one of these images, a seed of fear was planted.

And then there are the scary birth stories. Some women wear their traumatic birth story like a badge of honor and love to tell pregnant women, “Childbirth will be the most painful experience you’ll ever go through.” I’ve even heard some say, “It’s so painful you’ll want to die.”

In addition to these inaccurate, harmful messages, a fear of death during childbirth can be triggered by our mind trying to wrap itself around the process of a human coming out of our body. Many women in my classes have reported a fear that their body will “rip open” during childbirth, or that their heart will give out because of the strain. Even though these are not things that will happen, women still believe it on some level, despite all the evidence to the contrary. Much of this fear comes from the unknown. They’ve never had a baby, and the mind takes them to the scariest place it can imagine. Or maybe they’ve had a baby and the birth was traumatic. Even though they survived the experience, a part of them believes the second time around will be even more traumatic.

When this fear is at its most intense, it has a name: tokophobia. According to an article published in Industrial Psychiatry Journal, tokophobia — a morbid, pathological fear of childbirth — can lead to avoidance of birth and sometimes results in a woman requesting a cesarean section. The authors report a number of circumstances that could trigger tokophobia:

Hearing traumatic birth stories: This is a big one. When women we trust go on and on about traumatic birth experiences, we start to think, “If it happened to them, it could happen to me.” And sometimes, we take it to the next level, thinking, “But I probably won’t be as lucky as they were. I’ll probably be the one that dies because of those complications.” But the likelihood of that is really, really rare.

Concerns about the competency of medical professionals: Fear is an understandable byproduct of not trusting that hospital staff or midwives can keep you safe. If you’re convinced you won’t be properly cared for if you require medical intervention, it’s likely that you have experienced some form of negligence regarding medical care, or heard stories of those who have. Whatever the reasons, the “What to do” section will provide ideas for working through this.

Low self-esteem: If we don’t think highly of ourselves, it’s hard to believe our mind and body can withstand the rigors of childbirth. (But it can!) This wavering belief in our ability to birth can water those aforementioned seeds of fear.

The good news is you don’t have to just grin and bear this often-debilitating fear, regardless of where it’s coming from. There are ways to face it, then move past it.

What to do

One of the most crucial steps to overcoming this fear is realizing it’s not a sign of what’s to come. Even if your mind believes on the deepest level that your birth will not have a good outcome, it doesn’t make it so. Keep reminding yourself that the fear is a false construct of your mind, built by outdated information and stories that are part of someone else’s false constructs or need to impress. And above all, know that you can overcome the fear. Know that the fear doesn’t own you. Know that you are stronger than the fear. The following steps will help you believe that:

Find a care provider you feel safe with. Few things are as reassuring as hearing a care provider you trust tell you that they’ll keep you safe during childbirth. They can explain the protocol for all the situations you’re afraid of, and they can share uplifting stories of births they’ve attended.

The key here is that you trust them. If that trust isn’t there, their reassurance won’t mean much. So interview care providers until you find one who makes you feel safe. While it’s common to have to interview a few before finding the right one, you might also discover that you don’t trust any of them, regardless of how many candidates you interview. If this is the case, you might need to work with a mental health specialist to unpack and examine your unique trust issues with medical care providers.

Write about what you’re afraid of. An interesting thing about fear is that when we name it, it loses some of its power. So write down why you think you’ll die during childbirth. Can you pinpoint where that comes from? Are other fears about pregnancy or childbirth fueling your fear of death? Write it all, letting the words flow until you find clarity. Then, make a list of the primary fears and discuss them with your care provider and/or a mental health specialist.

Carefully select the prenatal testing you’ll undergo. The testing that can be utilized during pregnancy is a double-edged sword. On one side, the testing can offer reassurance if it confirms everything is fine. On the other side is anxiety that can be triggered while waiting for test results, in addition to the fears that arise if results are abnormal. Because of this, it’s crucial to be selective about the testing you agree to. Speak with your care provider about what is available, and what they recommend, then carefully determine what tests are ideal for your unique situation and comfort level.

Avoid scary birth stories. If someone tries to tell you their birth story, stop them and say, “I would love to hear your story if it’s not traumatic and won’t scare me. If you think it will, I would like you to wait to share until after I have my baby.” In addition, if you come across an article, television show, or other media source that portrays birth in a scary light, skip it. You don’t need to be an expert on worst care scenarios; that’s why you have a doctor or midwife.

Reach out to loved ones. The aforementioned study published in Industrial Psychiatry Journal found that there was a 50 percent reduction in elective C-sections when women experiencing severe fear of labor and delivery told trusted friends and family members how they were feeling and asked for support.

Hire a doula. Because feeling heard and supported is such a big part of unraveling your fear of death during childbirth, seeking the support of a doula can offer significant relief. To make sure you find the right person, ask friends for referrals, and keep interviewing candidates until you find the one who is a giant yes for you. You can also get a feel for how they’ll support you through your fear by bringing it up during your initial meeting. How they respond will be indicative of how they’ll support you through it during birth.

Count to ninety when you feel the fear. Any emotion takes ninety seconds to pass through you if you don’t stop it. So when you feel that fear of death gurgle up, think, “Oh, look at that. There’s that fear. I’m not going to ignore it. I’m going to sit with it.” Then set a timer for ninety seconds, and feel the fear until the timer beeps. Anytime you feel the emotions attached to the fear come back, repeat this exercise.

Create an arsenal of relaxation techniques. In addition to the ninety-second fear release, collect practices that soothe you. For example, you could take deep breaths, envisioning calm, trust, and comfort flowing in as you inhale, and fear, tension, and dread flowing out as you exhale. You could also repeat a mantra, such as, “I’m releasing this fear because it doesn’t own me. It is not real. I choose love and trust instead.” Or you can simply repeat, “I am safe.” As an added resource, download this guided meditation that was specifically crafted for releasing the fear of death during childbirth: yourserenelife.wordpress .com/fear-of-dying/.

Birth in the location that makes you feel safest. If the idea of birthing in a hospital freaks you out, consider birthing at home or in a birth center. But if you can’t imagine feeling safe anywhere but a hospital, go to the hospital. And it doesn’t matter what your partner, mom, friend, childbirth educator, or whoever thinks you should do. Do what makes you feel most secure.

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I’m a huge control freak and can’t stand the thought of not knowing when I’ll go into labor, what it will feel like, and how long it will take. How do I deal with all the unknowns?

Excerpt from Asking for a Pregnant Friend: 101 Answers to Questions Women Are Too Embarrassed to Ask about Pregnancy, Childbirth, and Motherhood

I’m a card-carrying member of the Control Freak Club. So not surprisingly, the unknowns of labor were one of the most difficult parts of pregnancy for me. I found it infuriating that even though millions of women have given birth, no one could tell me exactly what to expect. But alas, with the exception of women having a planned cesarean, there’s not a single lady who can know with certainty when she’ll go into labor, what it will feel like, and how long it will take.

Regarding the “When will I go into labor” component of this question, it’s important to note that due dates are far from an exact science. Only 5 percent of moms go into labor on their due date, most first-time moms don’t deliver until around ten days after their due date, and while some believe ladies who have already had babies will go into labor sooner, there’s no science to back that up. We just don’t know. While oxytocin is the hormone that stimulates contractions, what causes the release of that hormone is still a mystery. I hear you if you’re still like, “Okay, I get it. But come on, there must be something I can do to get things going?!” There’s an effective natural induction method I’ll cover below that may help you go into labor.

Now let’s look at the whole “What will it feel like?” thing. While con- tractions often feel like an intense blend of period and diarrhea cramps, I can almost guarantee the intensity is like nothing you’ve ever experienced.

And every woman experiences that intensity differently. For example, some experience it as rolling orgasms (jelly!), and others experience it as a call from the body to jump out the window. We don’t know exactly how the body and mind will process the intensity Moms who have already done the damn thing don’t even know what it will feel like with the next one, as childbirth is often different each time. But take heart, I’ll get to the part about how to prepare for this.

And finally, we have no stinking idea how many contractions we’ll have to have before that head pops out. Aargh. When it seems like you have to summon every fiber of your strength to get through each con- traction, it can feel deflating to not know how many more you’ll have to breathe through. If you ask women how long their labor took, you’ll get answers that range from a couple hours to a few days.

So yup. It can feel like a crapshoot, especially for women who (like me) use control as a security blanket. Birth throws that blanket out the window, leaving us cold and confused if we don’t know how to work through it. But luckily for us control freaks, there are ways through this fog of not-knowingness.

What to do

Well first, about that due date…

Think of your due date as a time of month, instead of one day. For example, a due date of May 15 becomes “mid-May.” This perspective shift helps release an obsession with a day that will likely come and go without a baby.

When my due date came and went, I panicked, thinking there was something wrong and that my baby wasn’t coming out because he probably definitely hated me. I was a wreck. I didn’t yet understand that due dates are far from an exact science, as fetuses grow at different rates, and the due date is predicted by adding 280 days to the first day of the woman’s last period, even though the length of women’s cycles varies. Because of this, only about 4 to 5 percent of women go into labor on their due date. So do as I didn’t, and break up with your due date, as this can dissolve the anxiety and sense of failure often attached to its passing.

Make an induction plan. If the last tip had you asking, “But won’t my care provider still be thinking about my due date?” you’re correct. Many care providers start dropping the I-word (induction) after your due date passes. If you’re not interested in induction, minimize your stress by creating a plan with your care provider, well in advance, about what you’ll do if you go past your due date. As you make the plan, stick to your guns, remembering you’re their client, not their patient. They can’t force you into a decision you’re uncomfortable with. If you feel like they’re badgering you during this conversation, consider switching care providers.

The plan many of my clients make with their care providers is to go to the hospital for nonstress tests (monitoring) if their baby hasn’t arrived by forty-one weeks. If the monitoring never shows fetal dis- tress, they keep on keeping on until baby decides to arrive.

Natural Induction Tip: If you go past your due date and feel anxious about getting things going, consider acupuncture, as it can be one of the most effective natural ways to induce. Just make sure you find an acupuncturist well trained in the art of induction, and you let your care provider know about it.

And now, here’s what to do about not knowing what birth will feel like:

Prepare. Take childbirth prep classes, practice the pain-relieving techniques you learn in those classes, read the books, and watch encouraging birth videos. Every time you put in this practice, tell yourself that what you’re doing will make the contractions more manageable — because it will. The breathing techniques, the pressure points, the tub, the essential oils, the positions — they all serve to get you through one contraction at a time. While they don’t eliminate discomfort, they will make it easier to manage.

Research epidurals. If you’re still fearful about the unknown pain after you prepare, research epidurals. That way, if that’s something you end up wanting, you’ll be confident you’re making a well-informed decision. This book provides epidural insights that can get you started.

Make peace with the unknowns. To infuse your pregnancy with more acceptance for all the unknowns, listen to this guided meditation: yourserenelife.wordpress.com/unknowns-of-childbirth/.

The main thing I want you to remember, no matter how you choose to get through the sensations of childbirth, is that you will get through them. They will not kill you, and they will absolutely help you realize your superhero strength.

To deal with the frustration of not knowing how many contractions you’ll have to get through, try these ideas:

Think of each contraction as its own event. Instead of concentrating on the unknown number of contractions you’ll have, focus only on one contraction at a time. As a new contraction begins to roll through you, tell yourself that all you have to do is get through that one con- traction. When it’s done, put your full attention on resting. Then reset, and do it again.

Remember that each contraction brings you one step closer to your baby. Even if you’ve barely dilated over a four-hour period, those con- tractions are still doing something, getting you nearer the enchanting moment of meeting your babe. So welcome each contraction, even if that sounds like crazy talk.

Don’t get too wrapped up in your cervix dilation number. While this number is a decent indicator of how far along you are, it doesn’t really help us know how much longer you have to go. For example, I once supported a mom who got to ten centimeters in three hours, then had five more hours of labor before baby was born. Another woman was at four centimeters for two days, then dilated to ten centimeters in forty-five minutes and had her baby an hour later.

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I know that millions of women have had babies and blah blah blah, but I keep thinking I’ll be the rare lady who can’t do it. How can I unlock my confidence and courage around my birthing abilities?

Excerpt from Asking for a Pregnant Friend: 101 Answers to Questions Women Are Too Embarrassed to Ask about Pregnancy, Childbirth, and Motherhood

I don’t think any woman — at her core — can fully fathom a baby coming out of her (unless she’s already had a baby). We can conceptualize it, but the reality of it seems unfathomable. Even when we nod in childbirth prep classes and feel we’re absorbing the information, it can feel impossible to get completely on board with the belief that a baby can exit our vagina, or that muscles and flesh can be expertly cut into so the baby can be retrieved. When we’re sitting at home — vagina, uterus, and abdominal muscles intact — it feels inconceivable that at some point the body will go through a wild transformation to allow the miracle creature within us to emerge.

The thing is, you don’t have to believe any of it is possible for it to be true. You’re off the hook for not fully buying into the fact that you can do it, because whether you believe it or not, you can do it and will do it. Whether “doing it” looks like having an unmedicated birth, Pitocin and an epidural, or a C-section matters not. All of it requires courage that will show up when the time comes.

It’s also important to remember that many other pregnant women can relate to how you’re feeling — a lot more than you realize. The very natural fears and doubts you’re experiencing are so much less isolating when you realize you’re part of a sisterhood that shares those fears and doubts. If you don’t feel chipper about the whole birthing thing, you’re not broken. You’re in good company.

However, having an enhanced belief in your ability to birth your baby can make the time between now and the moment you feel like you need to have a bowel movement but actually just need to have a baby a lot more enjoyable. So let’s get to some practical ideas for how to do that.

Try this:

Find your people. Reach out to pregnant women you know, or meet new ones by joining a prenatal exercise group or another type of gathering that attracts pregnant ladies. When you find a few candidates you connect with, invite them on a mama-date and share your feelings about birth. Many of them will likely respond with similar sentiments and support, helping you feel less alone and more understood. If they don’t, they’re not your people. But keep looking. They’re out there.

Take a childbirth prep class. Investing in this type of instruction can chip away at doubts about your birthing ability by teaching you how the body births a baby, without filling you with fear. It should also provide a bevy of techniques for pain and fear release and relaxation enhancement. Even if you don’t fully buy into the techniques, practice them, as your doubts likely come more from your deep-seated skepticism about your ability to birth than from insufficiencies in the methods. By forcing yourself to practice all of them at least once and continuing to practice the ones that resonate, you’ll build a powerful tool kit for birth. This tool kit will be utilized during birth whether you realize it or not.

As a doula, I’m often amazed to see the “tool kit techniques” that come up from the ether of my client’s subconscious during birth. I often hear, “I didn’t even decide to use that technique, it just happened.” This can occur only if your mind is filled with tools for pain relief and relaxation. Collect the tools, then trust that the ones that need to come to you will.

Treat yourself to a birth doula. Set yourself up for even more birthing confidence by hiring a doula who makes you feel safe and supported. A good doula comes equipped with in-depth knowledge of many of the tips and tricks you’re learning in your classes and books, and they can help you use the tools that will be most effective for your unique needs during each phase of labor and delivery.

If you’re concerned about cost, know that new doulas often provide their services pro bono to gain experience. You can also look into a volunteer doula program. There’s a list of organizations that connect

women with free or low-cost doula services in the “Recommended Resources” section of this book. You can also reach out to a doula in your community and ask them to refer you to a local organization, or specific doula, that provides affordable care.

Listen to this: To fortify your confidence-enhancing preparation, utilize this guided meditation, which helps you visualize yourself having a happy and healthy birth experience: yourserenelife.wordpress.com /enhancing-birth-confidence/. In addition, download this birth affirmations recording: yourserenelife.wordpress.com/feng-shui-mom my-birth-affirmations-download-link/.

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What if I don’t like my labor and delivery nurse? Do I just have to deal with them?

Excerpt from Asking for a Pregnant Friend: 101 Answers to Questions Women Are Too Embarrassed to Ask about Pregnancy, Childbirth, and Motherhood

Heck, no. If a nurse makes you feel uncomfortable, you get to “bye, Felicia” them. As the nurses assigned to you are the primary care providers you’ll have during birth (doctors usually just show up to help deliver the baby), you want them to make you feel safe and heard. If you cringe every time a certain nurse comes into the room, that’s a clear sign you need to request a different one. Many women don’t realize it’s even an option to ask for a different nurse, but it definitely is, and you won’t be the first person to utilize this right.

The thing is, not every nurse is a great fit for every mother. It’s not personal — it just means their vibe doesn’t jive with your vibe. If you’re wanting an unmedicated birth, for example, and you see the nurse roll their eyes when reading your birth plan, it’s clear their presence is not going to fill you with confidence or empowerment. And you deserve to feel confident and empowered. You deserve nurses who enhance your experience.

What to do

If a nurse makes you uncomfortable, think about what type of personality you would prefer. For example, do you want someone supportive of un- medicated births? Someone with a gentler energy? Someone who is direct and open with information? Someone with a good sense of humor?

Once you’ve determined what type of nurse you do want, ask your birth companion or doula to go to the nurses’ station and request to speak with the charge nurse, as they have the power to assign a new nurse. Your birth companion doesn’t have to go into detail about why you want a nurse reassigned, they can simply say something along the lines of, “My partner and I don’t feel that [insert nurse’s name here] is a good fit for us. We would prefer someone who is more [insert the traits you would like your new nurse to have].”

There’s no guarantee you’ll get the exact type of nurse you want, but chances are they’ll be a better fit than the last nurse, especially because they know you’re willing to advocate for yourself and are paying attention to how you’re treated.

While some women feel that requesting a different nurse is being dramatic, I think it’s one of the most empowered decisions you can make during birth. The people in your birthing space have a profound impact on how your birth unfolds, and you deserve to have the final say over who is and isn’t welcome. This is just another day of work for them, but it’s a monumental experience for you. You get to be as picky as you want. In addition, I wouldn’t worry about hurting anyone’s feelings — you’re not in the hospital to make friends, you’re there to have the happiest and healthiest birth experience you can.

Come prepared: Another option is to ask your care provider if they know of any nurses at the hospital where you’ll be delivering who they think would be a good fit for you. You can then ask for them by name when you check in. If those nurses aren’t available, ask if there’s a nurse who shares your general birth philosophy. For example, if you’re hoping to have an unmedicated birth, request a nurse who has had an unmedicated birth or is skilled at supporting them.

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Does anybody actually pay attention to birth preferences?

Excerpt from Asking for a Pregnant Friend: 101 Answers to Questions Women Are Too Embarrassed to Ask about Pregnancy, Childbirth, and Motherhood

Yes! There’s an annoying misconception that medical staff snicker behind a pregnant woman’s back if she presents birth preferences. If you’ve found a care provider you trust, they should fully respect your right to set intentions for your birth — which you can do with birth preferences. During my son’s birth, the nurses respected my preferences so thoroughly I had to ask them to ignore some of them when I changed my mind.

However, some care providers do see birth preferences as a threat to their position of power. They see it as someone trying to tell them how to do their job. But the thing is, you’re not a patient coming in for a standard procedure. You’re a healthy woman moving through a natural, biological process that requires the expert knowledge of a doctor or midwife only if a special circumstance comes up, or if you decide you want intervention. You’re not there to receive the care provider’s standard protocol. You’re there to cocreate an everyday miracle with your baby, body, care provider, and birth companions. And you deserve to be at the helm. No one else does. Your birth preferences are a way to plant a flag that says, “Unless my health, or my baby’s, becomes tenuous, this is how I want my birth to unfold. And I reserve the right to change my mind at any moment.”

What to do

Remind yourself over and over again that it’s your prerogative to take a stand regarding how you and your baby are treated during and after birth. This is a sacred experience that you get to guide. Once you’ve tapped into your confidence about your right to lead your birth experience, do the following:

  • Create your preferences. Contemplate each aspect of the birth experience (e.g., onset of labor, active labor, baby’s descent and emergence, baby’s care, and your care after birth) and write out how you’d like it all to play out. My book Feng Shui Mommy has a chapter devoted to birth preferences and includes a sample list you can find here: yourserenelife.wordpress.com/birth-preferences/. This list a good place to start if you’re feeling overwhelmed by the prospect of creating this document.
  • Phrase preferences in a positive tone. Help prevent defensiveness in your care providers by writing what you do want them to do, instead of what you don’t want them to do. For example, you could write, “I would prefer to labor without medication” instead of, “Don’t offer me medication.”
  • Keep it to one page. Your care providers are more likely to read all your preferences if you fit them all on one page.”. This often means that only the most important preferences make the list. You can always verbalize minor preferences.
  • Share preferences with your care provider. Take your preferences to a prenatal appointment at least six weeks before your due date. Have your care provider go through each preference with you. If you’ll be delivering in a hospital, ask if any of your preferences go against hospital protocol. If they do, you could decide to change the preferences, or prepare yourself and your birth companion to advocate for the preferences the hospital may push against. It’s also important to acknowledge that in the event of an emergency, you’re willing to let go of preferences that would inhibit quality care.

If your care provider seems exceedingly unsupportive of your birth preferences, consider hiring someone else.

  • Have extra copies. While the list of birth preferences you gave your care provider should make it into your chart, it may not. Ensure the list is at your birth by bringing at least two copies with you to the hospital or birthing center. And when you arrive, make sure everyone is on the same page by going over the preferences with support staff.
  • Adopt an attitude of adaptability. Remember that just because you wrote the preferences doesn’t mean you will have the exact birth they outline. The unexpected does happen, but the combination of understanding that possibility and still creating preferences sets you up for an empowered and satisfying birth experience.
  • Be thoughtful about the preferences you let go of. If someone besides you suggests pushing aside a certain preference while you’re in labor, think it over before agreeing (unless it’s an emergency situation). It can be easy to just say yes to whatever’s suggested when we’re on the wild journey of birth, but pausing, asking questions, contemplating, then making a decision that feels intuitively right for you allows you to write the story of your birth, instead of being a passive participant.

One mom I supported ended up changing her mind about almost all her birth preferences because of various circumstances that came up. But because she was the one opting to let the preferences go, instead of being forced into the decisions, she has positive memories of her birth experience. She felt confident in making the preferences, and confident in breaking them.

An article in the Journal of Perinatal Education found that a woman’s positive and negative perceptions of her birth experience are more connected to her feelings and ability to exert choice and control during birth than to the specific circumstances of the birth.

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What are my rights during birth? Do I have to do everything my care provider says?

Excerpt from Asking for a Pregnant Friend: 101 Answers to Questions Women Are Too Embarrassed to Ask about Pregnancy, Childbirth, and Motherhood

You have a lot of rights. Essentially, you have the last word on every facet of your care, and you don’t have to do anything your care provider suggests if you feel it’s the wrong call. But that’s where the water gets murky. Although you should be the key decision-maker during your pregnancy, childbirth, and postpartum experience, the people around you — specifically, your medical care provider — often hold ample sway in how things unfold. Intentionally or unintentionally, these people may manipulate your decisions based on legal or timing considerations, a hospital’s (possibly outdated) culture, or their personal biases. Fortunately, there are ways to get around this — the first being to know your rights. These include the following . . .

The Birthing Mother’s Bill of Rights

  • The right to receive thorough information about any intervention being recommended: You have a right to ask your care providers questions until you’re satisfied with the answers and feel you have enough information to make an informed decision. They should explain — in easily understandable terms — the risks and benefits of anything they’re recommending. You can also ask what information is evidence-based and what is just coming from their personal experience. And you can ask about the cost of everything, down to the stool sampler they’re offering you in that little white cup.

  • The right to request options: If you’re unsatisfied with a proposed course of action, you can ask for other options.

  • The right to turn down interventions: After receiving all the information, you may feel that an intervention is unnecessary. If this happens, it’s your right to turn it down. While you might not be a medical expert, you are an expert on what feels intuitively right for your body and baby. If everything in your being is screaming “No!” you get to listen.

And just because you (likely) signed a consent for care form when you were admitted doesn’t mean the care providers don’t have to obtain your permission before moving forward with any procedure.

The following are procedures that my clients are usually surprised are not obligatory:

Vaginal exams: While it can be nice to know how dilated you are, it’s not an essential part of childbirth. So you don’t have to let anyone perform a vaginal exam if they make you uncomfortable.

Heparin lock: Many hospitals strongly encourage women to accept a heparin lock — a catheter that is placed in a vein with a drop of heparin to prevent blood clotting and is then locked off — so they have an open vein should they need to hook you up to an IV. But you don’t have to agree to it.

  • The right to ask for a second opinion and/or change care providers: If you feel your care provider isn’t providing all the information or is leading you in a direction you feel uncomfortable with, ask to see another care provider. While the current care provider might push back, you’re doing nothing wrong by making this request.

  • The right to move around. If you want monitors, tubes, IVs, and so on removed so you can freely move around during labor, you can ask hospital staff to remove them. Your care provider might recommend staying connected to certain apparatuses because of medical needs, but they can’t force you to do so. You also have the right to get into the position of your choice when delivering your baby.

  • The right to privacy: No one gets to decide who is in your birthing space but you. If you want someone to leave the space, they have to comply, even if they work there. I once was a doula for a mother who felt unsafe around her OBGYN. When the baby was being delivered, she demanded that he leave and send in the on-call midwife. He was beside himself but had to do what she said.

  • The right to know who is in your birthing space. You have the right to know the identity and qualifications of any person in your birthing space.

  • The right to check out of the hospital. I’ve worked with many women who didn’t know they could check themselves out of the hospital “against medical advice.” If you don’t feel like you’re being treated well, you can leave the hospital and check into a new one. The hospital won’t make this easy, but what you’re doing isn’t illegal.

  • The right to receive records. You have the right to request copies of your medical records at any time, and to receive a comprehensive explanation of the contents.

  • The right to speak with hospital administration. If you feel your rights are being violated, you can ask to speak with a supervisor.

  • The right to be treated like the empowered, intelligent woman that you are. No one has a right to talk down to you, or make you feel like you’re not equipped to make well-informed decisions about your body and baby. If someone treats you without respect, you can turn around and demand it.

Note: Demanding your rights in some of these situations may require you to go against your care provider’s recommendations. If the doctor feels strongly enough about a recommendation, you may be required to sign a document confirming your choice to refuse care.

What to do

In addition to understanding your rights, there are numerous ways to ensure that you have care providers who not only honor your rights but encourage you to stand up for those rights. And if you end up being cared for by individuals who don’t respect your rights, despite your valiant efforts (it happens to the best of us!), here are some tools for those situations:

  • Find a care provider who believes in “patient autonomy.” See “Essential Tips for the Journey” on page xx for more information.

  • Create a thoughtful list of birth preferences. I love me some birth preferences. Not only are they a golden opportunity to pour positive intention into your birth experience, but they also allow you to clearly state how you expect to be treated. While all care providers should be well informed of your rights, your birth preferences serve as a clear reminder of what those rights are, and which ones are of particular importance to you.

  • Hire a doula. While most doulas won’t be your voice during birth, they can be the Birthing Angel on your shoulder, letting you know if someone is not honoring your rights. They can also provide ideas for how you and your birth companion can advocate for those rights.

  • Take two childbirth preparation classes. If you’re planning on giving birth in a hospital, I recommend taking both the childbirth prep class offered by the hospital and a class not affiliated with the hospital. I encourage you to take the hospital class first to gain insight into the hospital’s birth culture and what rights you might have to advocate for. This class is largely for recon, and I suggest keeping a running list of questions and concerns about information shared there.

Then, take this list to a childbirth preparation class that’s aligned with your personal birthing philosophy — for example, HypnoBirthing or Lamaze — and share it with the instructor. The instructor can likely help you determine whether there are any red flags that suggest you should find a new hospital, or provide guidance on how to navigate aspects of the hospital’s birthing culture that might go against your own. Both classes will likely help you become more informed and equipped to have an empowered birth experience.

Be clear when refusing treatment. If you ever need to go against your care provider’s recommendation, make it explicitly clear that you’re doing so. You might even need to request they provide verbal confirmation that they understand your decision.
Research the laws in your area. Because each state has their own laws when it comes to childbirth, it’s wise to email the American College of Obstetricians and Gynecologists Resource Center at resources@acog .org and ask for guidance finding the most up-to-date regulations for your state.

Fortify your courage. Advocating for your rights can be difficult, especially in the face of a strong-willed care provider adamant that you follow their lead. But you are so much stronger than you realize, and pushing yourself to call on that innate power during one of the most important experiences of your life will likely transform the experience. Listen to this guided meditation to tap into your inner power source: yourserenelife.wordpress.com/birthing-rights/.

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I don’t want my partner at our child’s birth. Is there something wrong with me? Should I just get over this feeling? Do I even have a say in whether they’re there or not?

Excerpt from Asking for a Pregnant Friend: 101 Answers to Questions Women Are Too Embarrassed to Ask about Pregnancy, Childbirth, and Motherhood

Oh, partners. They can be lovely, but they can also fudge things up during birth. So it’s more common than you’d think for women to not want their partner present during childbirth. However, few women admit it, even to themselves, because not wanting a partner present at birth makes many moms-to-be think there might be something fatally wrong with their relationship. But not wanting your special someone there while you birth your other special someone doesn’t mean your relationship is doomed.

I’ve heard numerous reasons why women want to have only a doula, or maybe their mom, sister, or nursing staff, present at birth. One mom I worked with (we’ll call her Emily) had a hubby who got seriously squeamish in hospitals and once passed out after seeing blood from a cut. Emily was worried that instead of supporting her, the medical team would end up caring for her husband. Another mom (we’ll call her Yvonne) had a partner who never wanted her to be uncomfortable. If Yvonne were sick, her partner would fuss over her until she had to ask for space. Yvonne worried that her partner’s overattentiveness might be distracting during birth. The other woman who comes to mind (we’ll call her Cassandra) had a boyfriend who was adamant that she not get the epidural, but she wasn’t sure how she felt about the epidural. This sparked discord.

I worked with these moms on plans for discussing these concerns with their partners. In the first two cases, the couples decided to have the partner present only at the very end, when the baby was emerging. And for Squeamish Dad, a nurse was assigned to him in case he got woozy. Regarding No Epidural Dad, when Cassandra determined the epidural was the right choice for her, he couldn’t support her, and they decided it would be best for him to join her after their baby was born.

There are numerous reasons women might want their partner to support them from a distance during labor — and they’re all totally legit and worthy of attention. While your partner is of course an important part of the equation and will be likely a huge part of the child’s life, childbirth is all about what makes you feel most comfortable. While it’s monumental in many ways, birth is also a drop in the ocean of the child’s life; if your partner isn’t there, it doesn’t mean their connection with the baby will be scarred.

What to do

If you’re feeling like you might not want your partner with you during labor and delivery, do this . .

Spend time exploring the reasons behind this feeling. To start, ask yourself, “In what scenario would I be most relaxed?” Then, through good ole meditation, journaling, or talking with a trusted friend whose eyes won’t widen when you tell them your thoughts, get clear on what that optimally relaxed scenario will look like. Who is there? Where are you? What does the room look like? How are you being supported?

As you explore this scene, pay attention to whether or not your partner is there. If they are, how does their presence make you feel? What are they doing that does, or does not, make you feel relaxed? If you don’t see them there, examine and write down the reasons behind their absence.

Talk to your partner. If the previous exercise makes you realize you don’t want your partner at the birth, or want them present only during a certain phase of labor, summon the courage to talk to them. While this may feel like the last thing you want to do, know that having this conversation will seriously lighten your emotional load and help you have a more positive birth experience.

If the reasons you don’t want your partner at the birth strike deep chords in your relationship, it could be beneficial to have this discussion with the support of a counselor. You can even see the counselor alone first to talk through your concerns and make a game plan for how this request for nonpresence will be presented to your partner.

However, if your reasons are more basic, as with the queasy husband or overattentive partner I mentioned, you’re probably safe just having a sit-down with your person. You can start the conversation by asking, “Have you thought about how present you want to be at the birth?” See what they say. You might find that they’re also hesitant about being there. Or they might be full of ideas about how they’ll coach you through breathing and get you into squats. Either way, exploring this topic together will either help you become more resolute in your decision to not have them there, or dissolve many of your initial concerns. After the first phase of this discussion, decide whether you’re good to move forward with the “This is what I want to happen during birth” portion of the talk, or need time to process what was shared.

Make a plan for partner’s involvement. When you’re clear on what you need from your partner, make a plan for how involved (or not involved) they’ll be during birth. While it might be tempting to make concessions in favor of their feelings, make sure to not make compromises that limit your comfort. This conversation could be uncomfortable on the front end, but you will feel so much better when it’s all out in the open and you can move forward.

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I’ve been craving inedible items like clay and dirt. What the heck is going on?

Excerpt from Asking for a Pregnant Friend: 101 Answers to Questions Women Are Too Embarrassed to Ask about Pregnancy, Childbirth, and Motherhood

A craving for nonfood items does not mean you’re losing your mind, it means you’re likely experiencing a type of eating disorder called pica. While rare, pica can crop up during pregnancy, surprising women by summoning the desire to eat clay, dirt, cornstarch, laundry detergent, and other inedible items. And although ice isn’t inedible, a regular craving for it could also be linked to pica. For some women, pica pushes them beyond cravings, causing them to actually eat their substance of choice.

These cravings are often caused by a deficiency in iron, zinc, iodine, calcium, thiamine, vitamin C, or other nutrients. Pregnant women, especially those with pre-existing conditions or chronic morning sickness, are prone to these deficiencies. I had an intense desire to chow down on snow during my pregnancy. Come to find out, I was anemic.

Pica requires immediate attention, as a lack of nutrients can cause uncomfortable symptoms and impact fetal growth. In addition, ingesting inedible items could be toxic for the mother and baby.

What to do

See your care provider ASAP. They will likely order tests to see if you’re deficient in iron, zinc, iodine, or other nutrients, in addition to performing other evaluations they deem necessary. When nutritional deficiencies are found, care providers typically recommend diet changes or supplements. If they suspect a part of the issue is psychological, they might refer you to a mental health specialist.

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I smile and nod when my care provider is talking, but I have no idea what half the terms or tests they’re mentioning mean. Can I have a crash course on the words coming out of my care provider’s mouth?

Excerpt from Asking for a Pregnant Friend: 101 Answers to Questions Women Are Too Embarrassed to Ask about Pregnancy, Childbirth, and Motherhood

You got it, toots. Being pregnant can feel like entering an alternate universe where everyone is speaking in baby-tongue, and you just smile and nod because it’s too overwhelming to stop all the baby people every twenty seconds to ask for a definition and explanation. When I went to prenatal appointments, I begged my mind to become a steel trap that could capture all the words my care provider said that I didn’t understand, so I could later ask Google. Why didn’t I just ask my doctor questions, or write down a list in the moment, you ask? Because I was petrified of being seen as illiterate in pregnancy and birth talk. Looking back, I feel so bad for that version of myself. Of course I didn’t know all that stuff — I had never been pregnant before! I wasn’t yet part of that world.

So that’s my long way of saying, when your care provider starts rattling off gibberish, don’t be afraid to pipe up and say, “I actually have no idea what you’re talking about. Please rewind and explain.” To help you out, here are some of the more uncommon terms your care provider might use. There’s also a full list of pregnancy and childbirth terms and definitions in the glossary.

Pregnancy Term Cheat Sheet

amniocentesis: A test typically done between sixteen and twenty weeks’ gestation to test for developmental abnormalities in the fetus. To perform the test, the care provider inserts a hollow needle into the uterus to retrieve a sample of amniotic fluid. This is most commonly done for women thirty-five and older.

APGAR score: A measurement of how baby is handling life outside the womb. The care provider usually performs this evaluation about one to five minutes after birth by rating the baby’s color, heartbeat, reflex, muscle tone, and breathing (which is what APGAR stands for: appearance, pulse, grimace, activity, and respiration). The score ranges from 1 to 10.

birth doula: A person trained in childbirth who provides emotional, educational, and physiological support before and during childbirth. They do not provide any medical assistance, but instead support mom with tasks like the creation of birth preferences, navigating choices during childbirth, utilizing pain- and fear-relieving techniques, and overall helping mom have a calm and empowered birth experience. Birth doulas often support the woman’s partner as well.

cerclage: A procedure sometimes done for a woman with an insufficient cervix (the cervix opening too early). In this procedure, stitches are used to close the cervix. They will be removed near the end of pregnancy.

colostrum: The first substance that comes out of a woman’s breasts after birth. Nicknamed “liquid gold,” colostrum often has a yellowish color and is filled with high levels of protein, salts, fats, and vitamins. Many consider colostrum a superfood for newborns, as it boosts their immune system, coats the stomach and intestines to help prevent illness, acts as a laxative, can prevent jaundice, and lowers blood sugar. You’ll only produce about one to four teaspoons per day, and it will be replaced when your milk comes in about two to five days after birth.

cord blood banking: The process of collecting blood from the umbilical cord and placenta after the cord is cut, freezing it, and storing it in a cord blood bank. Some parents elect cord blood banking because the blood contains hematopoietic stem cells that can be used to treat diseases like leukemia and lymphomas, in addition to some disorders of the blood and immune systems, such as sickle cell disease and Wiskott-Aldrich syndrome. The stem cells can benefit the child or their first- or second-degree relatives.

cord prolapse: A rare, serious complication that involves the umbilical cord dropping through the cervix and into the vagina, before the baby. If you can see the cord (which is not always the case), call 911 and lift your butt into the air, to get the weight of the baby off the cord.

delayed cord clamping: The practice of allowing the umbilical cord to stop pulsating before it is clamped and cut. This allows blood from the placenta to be transported into the baby, sometimes increasing the baby’s blood volume by up to a third, minimizing iron deficiencies and supporting brain development.

dinoprostone (Cervidil): A medication, usually administered as a vaginal insert, used to soften the cervix. One of the mildest forms of induction medication, dinoprostone is often utilized before misoprostol (Cytotec) and synthetic oxytocin (Pitocin). A woman must remain in bed for two hours after insertion; it is removed after twelve hours, or when labor is established.

effacement: The thinning of the cervix. The cervix starts out being about three to four centimeters long, and as labor progresses it gets shorter, thinner, and wider (dilation).

engaged head: The settling of the baby’s head into the pelvis. This generally happens during the end of the third trimester when you’re nearing labor. When this happens, you’ll typically be able to breathe easier, as there’s less pressure on your diaphragm. You might also feel increased pressure in your pelvis.

external cephalic version (ECV): A process used to turn a breech baby into the head-down position for birth. In an ECV, the mother is typically given a medication (via IV) that relaxes her uterus, and then a care provider strategically presses on various areas of the abdomen, trying to turn the baby. An ultrasound is sometimes used to guide the process, and the baby’s heart rate is closely monitored. And will it hurt? Probably. If you need an ECV, use it as practice for childbirth by putting your breathing techniques and other relaxation tools to work.

fontanelles: The two spaces between the baby’s five skull bones where the sutures (soft membrane gaps) intersect. Also known as “soft spots.” The fontanelles are covered by strong membranes that protect the brain. They are located near the front of the skull and on the crown. While many new parents are terrified they’ll poke a hole in baby’s head if they accidentally touch one of these spots too hard, you won’t — they’re a lot tougher than they look (both the spots and the baby as a whole). They should usually close by baby’s twentieth month.

group B strep (GBS): Naturally occurring bacteria that can cause serious illness in newborns. When I tested positive for this, I logically thought it meant pregnancy had given me an STD. But no. GBS is a bacterial infection found in the vagina or rectum of about 25 percent of women. Between weeks thirty-five and thirty-seven of gestation, a swap test will be used to determine if you have GBS. While it typically does not cause symptoms in the mother, it can be dangerous if passed to the baby during delivery. Because of this, care providers often recommend that women who test positive be given IV antibiotics at the onset of labor and then every four hours until baby is born.

lanugo: Fine, soft hair covering the newborn in the womb and helping a protective layer of vernix stick to the skin. The hair usually sheds around month seven or eight of gestation, but it sometimes sticks around for many weeks after birth. Lanugo is most commonly seen on babies born prematurely.

lochia: Vaginal discharge present after birth that contains blood, mucus, and uterine tissue. It typically lasts for four to six weeks, but usually it isn’t too heavy after the first week.
misoprostol (Cytotec): A medication (pill) used to induce labor, administered orally or vaginally. The use of misoprostol is controversial, as it can cause hyperstimulation of the uterus and other potential complications, according to a study published in the Journal of Perinatal Education.

nonstress test: A test done in the hospital or birth center to confirm baby’s health in the womb. It’s noninvasive and only consists of baby’s heart rate being monitored. Care providers specifically want to see how baby’s movements impact their heart rate, as their heart should beat a bit faster when they move. It usually can’t be done before week twenty-six of gestation.

nuchal cord: An umbilical cord that is wrapped around baby’s neck. While it sounds scary, nuchal cord is rarely dangerous. According to a study published in Maternal Health Neonatal Perinatal, 10 to 29 percent of fetuses experience nuchal cord. My little overachiever also had this.

nuchal hand: When baby’s hand is by their face when they’re born. Also called compound hand. My son did me the favor of being in this position as I pushed him out. Nuchal hand is likely what made that stage of labor take longer, and made it so hard I sounded like a constipated boar whilst pushing.

placenta abruption: A rare occurrence where the placenta prematurely detaches — either partially or completely— from the wall of the uterus, sometimes causing heavy bleeding and a lack of oxygen for the baby. If this happens early in pregnancy, the baby will be closely monitored through ultrasound. If it occurs later in pregnancy, the baby will probably be delivered through C-section.

placenta accreta: When the placenta grows too deeply into the uterine wall. This often prevents the placenta from detaching completely from the uterus after baby’s birth, which could cause hemorrhaging. In this situation, the baby is usually delivered through cesarean. And in severe cases, a hysterectomy (the surgical removal of the uterus) may be required.

placenta previa: When the placenta is covering part or all of the cervix. The primary symptom is vaginal bleeding (often with bright red blood), unaccompanied by pain. Sometimes, placenta previa resolves itself. When it doesn’t resolve by the time a mother is full term, the baby is often delivered via cesarean.

postpartum doula: What I like to call an “Earth angel” — an individual trained to swoop in for a few hours each day, for the first few weeks of baby’s life (or more!), to provide support with breastfeeding, infant care, and mama’s emotional and physical recovery. In addition, postpartum doulas often help with housekeeping, meal prep, errands, childcare for siblings, and pretty much anything the parents and baby need.

prodromal labor: The frustrating phenomenon of early labor that feels like much more than Braxton Hicks contractions but isn’t actually doing much to dilate the cervix. However, this type of labor isn’t totally pointless, as it can help baby get into the ideal position and prep the muscles, pelvis, and your brain for active labor. This is different than early labor because the contractions often start and stop (for example, you might have them only at night), instead of progressively getting longer, stronger, and closer together, as often happens when a woman is experiencing early labor that transitions into active labor. I recommend using prodromal labor as an opportunity to get into the groove of birth by practicing pain-relieving techniques, even if the contractions aren’t intense.

Rh factor testing: Ready for a science lesson? Here goes. Rh is a protein found on the surface of red blood cells. If you have the protein, you’re Rh positive. If you don’t, you’re Rh negative. Most people are Rh positive. During your first prenatal visit, your care provider will likely order a blood type and Rh factor screening test to see what blood type you’re working with. If you’re Rh negative, the baby’s father will be tested. If the man is Rh positive, it’s likely your babe is also Rh positive, which means the two of you are Rh-incompatible. In this case, your care provider will likely recommend the RhoGam shot.

Rh immunoglobulin (RhoGAM): If you and baby are Rh-incompatible, you’ll get a shot of Rh immunoglobulin (brand name RhoGAM) during week twenty-eight of pregnancy, and within seventy-two hours after delivery if it’s confirmed that baby is Rh positive. The shot prevents your body from making antibodies during your first pregnancy that could attack the fetus during subsequent pregnancies. Without the shot, your immune system would detect the foreign proteins on baby’s blood cells (foreign only if you’re Rh negative and they’re Rh positive) and create antibodies so it could attack the foreigner should it show up again — which it would if you get pregnant again with an Rh positive baby.

transverse: When baby is lying sideways, instead of head down. Most babies transition into head down, but if they don’t by around thirty-six weeks’ gestation, your care provider might recommend an ECV.

vernix caseosa: A waxy, cottage cheese–like coating on baby’s skin that protects them from the “pruning” effects of amniotic fluid. In addition, when baby swallows vernix caseosa in utero, it can help develop their gut bacteria, serves as a lubricant during birth, protects baby from bacterial infections after birth, and helps heal vaginal tears, as the vaginal opening is exposed to it as baby emerges. Because of these post-birth benefits, the World Health Organization recommends waiting six hours before giving baby a bath. If you want to maximize these benefits, request on your birth preferences that baby not be wiped off after birth, and that their first bath be delayed.

vertex: When a baby in utero is positioned head down.

What to do

Review these phrases, but don’t be afraid to ask questions when someone starts talking in terms (or recommends tests) you don’t understand. People love to feel smart and impart wisdom to others — so you’re giving them a gift by asking the questions.

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I’m over thirty-five, and when people refer to my pregnancy as geriatric I want to scream. How can I ask them to use a different term? And how can I shift my own beliefs around being an “old mom”?

Excerpt from Asking for a Pregnant Friend: 101 Answers to Questions Women Are Too Embarrassed to Ask about Pregnancy, Childbirth, and Motherhood

Ugh. Whoever came up with the term geriatric pregnancy should be sentenced to a month of watching nothing but infomercials. I mean really,

I can’t think of a better term to make a woman feel like her body is ill equipped to carry a healthy pregnancy. While science has shown us that as women (and men!) age, their fertility declines and rates for various special circumstances increase, it’s absurd to make every pregnant woman who is thirty-five or older join the Geriatric Pregnancy Club. In many ways, factors such as lifestyle, physical and mental health, and genetics play a much bigger role than age in how a woman’s body handles pregnancy. If you rock a healthy lifestyle, you likely have a much better chance of having a thriving pregnancy than a twenty-five-year-old who smokes, drinks, and thinks healthy eating is getting sliced strawberries on top of a funnel cake.

Understanding the offensive nature of the term geriatric pregnancy, many now slap the label advanced maternal age (AMA) on pregnant women thirty-five or older. But that’s not much better. Why do we need to label these women at all? Why can’t care providers just look at each pregnant woman as a unique human? Why can’t we look at her personal and family medical history, current health, and other personalized factors to determine what testing she should have and what circumstances she might be at risk for, instead of automatically treating her as a geriatric, and therefore high-risk patient?

To be fair, many care providers do treat women thirty-five or older in this customized manner, understanding that just because she’s been on Earth for a set number of rotations doesn’t mean she needs to see a high- risk doctor, get that amniocentesis, and schedule a C-section (something three of my clients were told they should have, simply because they were in their early forties). These are the care providers you want to find, primarily because if you’re seen by a care provider who perceives you as high risk only because of your age, you might have a higher chance of receiving unneeded interventions because their misguided perceptions color their recommendations.

More and more research is also showing that women of AMA aren’t actually at much higher risk for many of the special circumstances often attached to “geriatric pregnancies” than their younger counterparts. For example, a study published in Scientific Reports found that pregnant women over the age of thirty-four had only a slightly increased risk for gestational diabetes mellitus and hypertensive disorders than younger women. These researchers also found no increased risk of postpartum hemorrhage, preterm birth, low APGAR scores, or NICU admission for the babies of AMA women. And according to a study published in the journal Human Reproduction, women aged eighteen to thirty-four had a stillbirth rate of 0.47%, while women between thirty-five and forty had only a slightly higher stillbirth rate, at 0.61%.

So enough with the derogatory labels. It’s time for a change.

What to do

Minimize the anxiety that’s often produced by all the chatter about a geriatric pregnancy by trying the following:

  • Find a care provider who doesn’t make you feel like a dusty china doll. There are a ton of amazing care providers who also roll their eyes at the term geriatric pregnancy. Put in the effort to find one. Ask friends and family members (especially those who had a baby after the age of thirty-four) for recommendations, and have a consult with your top choices. Ask them what their views are on women having babies after thirty-four, then hire the care provider who makes you feel most empowered about your ability to have a healthy pregnancy and birth experience, regardless of your age.
  • Ask for a reframe. If the care provider you eventually choose or someone who works with them drops the term geriatric pregnancy, or even advanced maternal age, when referring to your unique pregnancy, ask them to stop, and tell them why. For example, if these terms replace your confidence and trust in your body with fear and doubt, explain that to your care provider. You can tell them you’re fine hearing about the tests and precautions they recommend (unless of course you’re not), but you’d like to keep labels out of the discussion.
  • Remember that you’re a one-of-a-kind woman, not a statistic. Viva the cliché “Age is just a number.” It truly is just a number and means very little when it comes to how healthy your pregnancy will be. For example, my client Ava had her first baby in her early twenties, when she was a self-proclaimed “fast food addict.” She felt bloated, tired, and “fuzzy minded” during that pregnancy, which ended in an emergency C-section because of pre-eclampsia. When her thirties began, she cleaned up her lifestyle, and she became pregnant again at thirty-three. She loved this pregnancy, which came with ample energy, mental clarity, and no special circumstances. She had a complication-free vaginal birth after cesarean (VBAC). I saw pictures that proved she also looked younger in her thirties than she had in her twenties. So if all the lame geriatric labels are getting to you, remember that how you feel is much more important than the date on your birth certificate.
  • Work your plan for healthy eating and exercise. Taking those prenatal vitamins and omega-3 supplements; loading up on fruits, veggies, and other nutritious fare; drinking lots of water; moving your body; and sleeping at least seven or eight hours a night will do wonders in helping you have a healthy pregnancy.
  • Be curious about all the recommended tests. When you reach the age of thirty-five, care providers often recommend a heap of tests. If you feel good about all of them, great. But if you feel unsure about what is actually necessary, ask questions until you feel satisfied with the quality and clarity of the information you’re receiving. In addition, doing your own research can fortify you with information that may have been left out because of your care provider’s biases. However, make sure your resources are reliable. Studies published in peer-reviewed journals are a good place to start, and many can easily be found online.

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I succumbed to sushi and a glass of wine. Am I the worst pregnant lady ever?

Excerpt from Asking for a Pregnant Friend: 101 Answers to Questions Women Are Too Embarrassed to Ask about Pregnancy, Childbirth, and Motherhood

No way, mama. While I certainly wouldn’t advise downing alcohol and raw fish on the regular without your care provider’s go-ahead, that fish with a side of red wine can actually help reduce anxiety. A plant compound found in red wine, resveratrol, creates anxiety-soothing effects by blocking the expression of an enzyme that controls stress in the brain.

And then there’s the sushi. A study published in the peer-reviewed journal PLoS One found that pregnant women who ate oily fish high in long-chain essential n-3 polyunsaturated fatty acids (PUFA) and docosahexaenoic acid (DHA) had lower levels of anxiety than their vegetarian peers, as these compounds are essential for optimal neurological function and impact mood changes. The study also reported that because baby is taking many of those happy compounds, the mom can easily become depleted, meaning she really needs to stay on top of her fish intake. Two to three servings of low-mercury, fatty fish each week is recommended.

With all that said, there are still concerns about drinking too much alcohol and eating fish raw. So what’s safe, and what should be avoided? Concerning alcohol, there is no evidence proving light consumption (up to two glasses a week) is harmful to the fetus. But because heavy drinking can be incredibly harmful, many care providers recommend abstaining “just in case.” Essentially, the light-drinking-while-pregnant question is still a bit of a grey area, but almost any care provider will tell you that having a few (very spread out) glasses of wine during your pregnancy shouldn’t be an issue.

Now let’s debunk the belief that raw fish is the enemy of a healthy pregnancy.

  • A primary fear about raw fish is that it will expose you to parasites. However, most fish is flash frozen before shipment, which kills parasites.
  • If salmon is your fish of choice, it’s likely farmed instead of wild, making it much less susceptible to parasites.
  • A study published in Obstetrics & Gynecology reported “sushi that was prepared in a clean and reputable establishment is unlikely to pose a risk to the pregnancy.”
    What you want to stay away from, more than that salmon roll at your local sushi spot, are fish dishes (cooked or not) that are high in mercury. King mackerel, marlin, swordfish, tilefish, ahi tuna, and bigeye tuna are all fishies to steer clear of.

According to a study published in Clinical Microbiology Reviews, most seafood-related illnesses are caused by shellfish, not fish.

What to do

If you’re mourning the loss of your vino and rainbow rolls, talk with your care provider about what would be safe for you to consume in your unique situation. You might find that because of certain special circumstances, it’s best for you to stay away from alcohol and raw fish most of the time. But if you’re having a healthy pregnancy, your care provider may surprise you by giving the go-ahead for a glass of wine and some sashimi once a week, for example. The answer you get will likely depend on the research the care provider has been exposed to and how conservative they are. If they give you an answer that feels off, don’t hesitate to dig deeper, asking them about their reasoning for the answer they provide. And if you really want to get a breadth of opinions, reach out to other care providers — making sure to throw some midwives into the mix.

If you’re cleared for intermittent treats, make sure to select the healthiest options. For example, if you can have wine from time to time, opt for an organic brand. Regarding sushi, only go to restaurants that provide super-fresh fish and have glowing reviews. Many cities have a public grading system for restaurants, helping patrons know which eateries passed their food and hygiene inspection with flying colors.

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I sometimes open my mouth to talk and a burp comes out instead. Why? And what’s up with my constant constipation and uncontrollable farting? Is there a way to minimize all this gas? Or to at least feel less embarrassed when it happens?

Excerpt from Asking for a Pregnant Friend: 101 Answers to Questions Women Are Too Embarrassed to Ask about Pregnancy, Childbirth, and Motherhood

Thanks to progesterone, your intestines relax during pregnancy, making digestion less efficient and increasing the time fecal matter stays in the intestines by up to 30 percent. The pressure of the uterus on the abdominal cavity also slows digestion. This can all cause constipation, which leads to a buildup of gas that can burst out your northern or southern orifices — sometimes smelling like sulfur. Female gas actually tends to smell more sulfur-y than man-gas because our farts have a higher concentration of hydrogen sulfide. Adding to our lady-luck is the fact that even if we’re not constipated, those relaxed bowels make it tricky to control gas leaks.

During my pregnancy naps, I was often awakened by belly-rumbling sulfur toots so smelly I would sometimes lose my lunch. Who says pregnancy isn’t glamorous?

While all the gas can make you blush, it also has some benefits:

  • It’s a sign you’re staying on top of your fruits and veggies.
  • The slow moves of your intestines allow more time for your body to absorb nutrients from food.
  • Farting and burping in front of your partner — or other loved ones — can be a strangely bonding experience, as it’s an ultimate sign of comfort.
  • Letting it rip with abandon actually makes your kisser more desirable, as holding in farts can make the breath stink.

What to do

Despite the benefits of passing gas, having too much of it gurgling around can be uncomfortable. The primary way to lessen that discomfort is revving up digestion. There are numerous ways to do that:

  • Move it or snooze it. A stagnant body usually leads to sleepy bowels. Get things going by talking to your care provider about an exercise plan that’s safe for your unique circumstances. Getting in thirty minutes of exercise every day is often enough to keep the intestines chugging along at a gas-minimizing rate.
  • Investigate your diet. If you notice that your gassiness intensifies after eating certain foods, consider eliminating them from your diet, or at least decreasing your intake. Foods that are especially gas-inducing include broccoli, cabbage, Brussels sprouts, artichokes, asparagus, onions, lentils, pork, fried foods, and artificial sweeteners. Many people also experience gas after consuming dairy or gluten. To support this recon mission, keep a food journal for a week, recording which meals made you burp or fart. Also know that you may experience more gassiness after taking your prenatal vitamin.
  • Soften your stools. Hard fecal matter leads to constipation, which leads to all the fun I’ve been outlining. Prevent brown bricks and pebbles from forming in your intestines by drinking plenty of water and consuming twenty-five to thirty grams of fiber every day, as fiber infuses the intestines with water. Prunes, bananas, figs, flax and chia seeds, blackberries, avocados, leafy greens, pears, and apples are all fiber-full. Fiber supplements can also provide a quick fix. Because I’m a lady blessed with lazy bowels with or without a bun in the oven, I start every day with prunes and Metamucil. My morning sex appeal is almost too much to handle.
  • Chew your food. As one cause of gas is bacteria in the large intestine breaking down food that wasn’t fully digested by enzymes in the stomach, adding to your chew count can lower your burp and fart count. Aim for chewing each bite of soft foods at least ten times, and denser foods at least thirty times.

In addition, slowing down your chewing (and drinking) and minimizing talking while eating can help limit the amount of air you swallow.

  • Eat smaller meals. Noshing on six small meals, instead of three big ones, spreads out the load your digestive system has to work through, minimizing backlog.
  • Sleep on your left side. This position aids digestion, helping you wake up ready to poo.
  • Say yes to the muumuu. Staying away from tight clothing — especially articles that squeeze the waist — allows your bowels to pulsate without restriction. In addition, loose clothing can reduce discomfort from bloating.
  • Filtered panties. That’s right folks, filtered panties are a thing, and a thing that can alleviate fear when feeling a big one coming on and thinking, “Will it, or will it not, be a stinker?” If you’re worried about the sound: A trick I often utilize is pretending like I’m talking to someone on my cell phone and letting out a laugh as I simultaneously let out the toot. You’re welcome.
  • Air freshener. If you’re still concerned with the smell after donning those filtered panties, do as I did and carry around an on-the-go bottle of an essential oil air freshener.
  • Seek professional care. If you experience constipation or abdominal pain for more than a week or feel like you’re rarely able to have a complete bowel movement, alert your care provider.

Let it be known that even if your bowels are always on their A-game, you’re still going to burp and fart, sometimes without warning. While it can feel embarrassing, know that it matters to you way more than it does to other people. Sure, others may clock your toot or belch, but they’ll likely spend only a second considering it, thinking, “Oh, so-and-so just farted/burped. But who cares? They’re pregnant.” Even when you’re not pregnant, who cares? We all do it. It’s been found that, on average, many people produce four pints of gas and fart up to twenty times every day.

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My various body odors and breath have gotten out of control. Is that normal? What’s a safe way to mask the stinks?

Excerpt from Asking for a Pregnant Friend: 101 Answers to Questions Women Are Too Embarrassed to Ask about Pregnancy, Childbirth, and Motherhood

This smelliness is totally normal, but as I’m sure you’re tired of hearing from me, you should still tell your care provider just in case it’s an indicator of a special circumstance. But it’s probably related to the following pregnancy phenomena:

Dragon breath: Progesterone can impact the slant between your esophagus and stomach, causing smelly gastric juices to bubble up. In addition, many women develop pregnancy rhinitis (fancy term for a chronic stuffy nose), which can lead to mouth breathing, which dries out the saliva that staves off the buildup of pungent bacteria. Underarm funk: The increase in your basal metabolic rate causes an increase in your blood supply and body temperature, prompting sweat glands to go into overdrive.

Shift in vaginal fragrance: This is caused by a change in the vagina’s pH balance, which produces a sweet scent that’s often compared to the aromas of glue or dough. Sometimes an odd smell can be created by a yeast infection, which is often accompanied by redness, itching, burning, or strange discharge. If you have bacterial vaginosis, a fishy, ammonia-like aroma will waft about.

What to do

Know that you’re probably the only person who thinks you’re stinky. Because your nose is seriously sensitive to smell during pregnancy, the aromas floating up from your mouth, pits, and vagina are exaggerated by your smell receptor. However, we don’t want you gagging over your odors. Try out the following to soothe the stench:

  1. Do hygiene on the go. Keep organic, unscented feminine hygiene wipes to freshen up your vagina and armpits when you feel the moisture collecting. In addition, always have organic deodorant on hand. And since food stuck in the teeth and bacteria on the tongue can get stinky, store dental floss and a tongue scraper in your bag.
  1. Shower on the regular. Start your day with a shower that ends with a cool rinse, so you don’t start sweating before you’re done toweling off. If you find yourself sweaty, sticky, and stinky later in the day, don’t be shy about taking shower deux.
  1. Use natural antibacterial products. After showering, minimize a buildup of bacteria by wiping an apple cider vinegar toner (mix one part apple cider vinegar with two parts filtered water) on areas that collect sweat. And as honey, coconut oil, cinnamon, and cloves also have antibacterial properties, using body oil or lotion infused with these ingredients can minimize unpleasant odors.

In addition, friction removes bacteria — so use a coconut sugar scrub once a week. To make, melt one-half cup coconut oil in the microwave for about forty-five seconds, or until completely melted. Then, mix in one cup white sugar and transfer mixture into a mason jar.

  1. Wash clothes with distilled white vinegar. Pour a half cup of distilled white vinegar into your washing machine during the rinse cycle, as this liquid is great at deodorizing clothes.
  1. Drink water. As a dry mouth is a mega-manufacturer of bad breath, drink water on the regular. Add to the freshness by mixing in a few sprigs of mint and a squeeze of lemon.
  1. Snack out the stink. Noshing on leafy greens, celery, cucumbers, pears, apples, pineapple, cherries, melons, citrus fruits, parsley, basil, and spirulina (stick it in a smoothie to mask its taste) can help erase funky breath. In addition, staying away from too much garlic, onion, and curry reduces your pungency.
  1. Avoid scented products. As tempting as it is to mask smells with perfumed lotions and sprays, many chemically produced scents can irritate skin. If you really want to conceal the scent, mix one drop of organic lavender, rose, ylang ylang, grapefruit, sweet orange, or lemongrass essential oil with one teaspoon of a carrier oil like almond or jojoba oil, and rub on pulse points.

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Why am I sweating so much?

Excerpt from Asking for a Pregnant Friend: 101 Answers to Questions Women Are Too Embarrassed to Ask about Pregnancy, Childbirth, and Motherhood

During my third trimester I would frequently awake to a pillow so drenched with sweat it was squishy. (And it made all the squishy sounds.) My night sweats and, heck, my all-day sweats were out of control. I looked, smelled, and felt like a Swamp Mama. It was really sexy.

Not surprisingly, it’s believed the intense sweating many women experience during pregnancy is due to the spike in estrogen and progesterone. (Those buggers seem to tinker with everything.) In addition, an increase in body temperature and blood flow to the skin contributes to the pregnancy glow, or for ladies like me, the pregnancy drench.

What to do

Let you care provider know. Although the sweats are likely just a side effect of growing a human, it’s wise to rule out circumstances like infection or thyroid issues. After you’ve determined all is well (besides the whole waking up in a swimming pool thing), minimize your excessive glisten by trying the following:

  • Exercise. It seems counterintuitive, but whether you’re pregnant or not, exercise has been found to reduce sweatiness (at least after the exercise).
  • Stay hydrated. While drinking water won’t make you sweat less, it will minimize overheating. It also helps you replace all the fluids you’re losing, which is crucial, as those fluids impact amniotic fluid levels, blood volume, new tissue production, nutrient delivery, digestion, and removal of wastes and toxins (bye, constipation). Hydration is crucial.

To ensure your sweating doesn’t impact your vitality, shoot for drinking your body weight in ounces every day. For example, a woman who weighs 140 pounds would drink 70 ounces every day. It’s a lot. But if you’re a sweating-overachiever, the extra fluids will be worth the effort. If your care provider is concerned about the electrolytes you’re losing via sweat, consider getting some of your fluids from coconut water and noshing on bananas, watermelon, and avocado.

You can also put a dash of pink Himalayan sea salt in your water.

  • Be cool in the bedroom. Minimize night sweats by lowering your thermostat to around 65 degrees Fahrenheit, turning on a fan, having a cup of cold water by the bed, and sleeping in sheets and pajamas made with breathable natural fibers like organic cotton, linen, or bamboo. (Percale is another cool option for sheets.) In addition, have an extra pair of pj’s and a clean sheet you can lay on top of your half of the soiled sheet at the ready, in case you still wake up soaked in the middle of the night.
  • Wear loose, breathable clothing. Nothing inspires sweat glands like a tight polyester dress or some snug rayon pants (hello, sweaty crotch). Do yourself a favor and swap the tight for the flowy, and the impermeable for the breathable. And just like the pj’s mentioned above, look for duds made with organic cotton, linen, or bamboo.
  • Powder your undies and thighs. You can prevent the heat rash or chafing that can be caused by an abundance of moisture in your nether regions by sprinkling organic talc-free powder (or corn starch!) in your undies and dabbing some on your thighs before putting on your bottoms. While there’s no evidence that talc-free powder in the vaginal area is harmful, it’s still wise to check with your care provider before your inaugural sprinkle.
  • Carry a folding fan. Look like the chic lady you are by keeping a folding fan in your purse and whipping that baby out whenever you’re feeling flushed.

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My boobs are so itchy I feel like sticking sandpaper in my bra. Why are they itchy, and how can I soothe them?

Excerpt from Asking for a Pregnant Friend: 101 Answers to Questions Women Are Too Embarrassed to Ask about Pregnancy, Childbirth, and Motherhood

If you walked through a Target parking lot in Los Angeles, summer of 2012, and saw a pregnant woman with her hand down her shirt and a “scratching that itch” face . . . that was me. (Target was my spot for napping and boob itching before making the hour-long drive home from work.) My breasts — nipples especially — became so insatiably itchy during my last trimester that I was itching my upper privates anytime I wasn’t in public. When I was home, I slathered cream all over them and walked around topless. It wasn’t cute.

There are numerous reasons for the tickling-teats phenomenon:

  • Hormones: Those dang hormones. As they build, they can create increasingly itchy skin, especially in the bosom.

  • Stretching: As if the visual of stretch marks weren’t irritating enough, stretch marks also exaggerate itchiness, as they cause the skin to dry out. Talk about adding insult to injury!

  • Eczema: The most evil of all itchy-booby culprits is pregnancy-induced eczema. This skin condition can make you feel like a body’s worth of chicken pox is condensed on your boobs. Not cool.

  • Prurigo of pregnancy: As the immune system adjusts to all the changes pregnancy throws at it, itchy, bugbite-like bumps, called prurigo, might appear on the skin.

  • PUPPP. Pruritic urticarial papules and plaques of pregnancy (say that five times fast) can cause bumps or hive-like rashes anywhere from the stomach to the boobs. If the sight of it weren’t fun enough, it’s also itchy. It will go away after pregnancy.

  • Intertrigo. Essentially, this is just an underboob rash caused by the three amigos heat, moisture, and friction.

  • Yeast infection. While yeast infections usually just party in your pants, they occasionally make trips up north, especially during pregnancy. Its party favors are usually dry, flaky skin and possibly bright red nips. If you suspect this is what’s going on, contact your care provider.

What to do

Stick that sandpaper in your bra. Just kidding. There are kinder ways to calm the itch:

  • Drink more water. Consuming your body weight in ounces of water (e.g., if you’re 140 pounds, strive for 70 ounces of water) every day will soothe many of these skin ailments, in addition to clearing up clogged bowels and a slew of other pregnancy annoyances. While this water recommendation is higher than most, it takes into account increased sweating, vomiting, and those days when you forget your water bottle.

  • Consider your boob hammock. A too-tight bra or one made of synthetic material could aggravate itchiness. Opt for a bra that’s done away with underwire and dye and can grow with your expanding melons. You can even start wearing nursing bras early, as they’re often mega-comfortable. In addition, make sure your bras are made with natural fibers like cotton or bamboo, which is more comfortable than it sounds.

  • Butter up your boobs. Alleviate the itch by applying shea or cocoa butter, lanolin cream, or jojoba or olive oil. Heck, straight-up butter would even help. Keep your anti-itch agent of choice in your purse so you can slather on the go. (Target parking lots are excellent for this activity.)

  • Don’t itch. I hate typing that because I hate when people tell me that. But alas, people are right. While it’s heavenly in the moment, scratching often intensifies the itchies and can make skin so raw you’re then itchy and in pain. Instead of scratching, pull out that boob butter.

  • Spring for organic, unscented detergent and skin products. As the chemicals in detergent, body wash, and lotion can all intensify the itch, switch to products that are organic and unscented.

  • Humidify. Because dry air almost always exaggerates itchiness, moisten the air by placing a humidifier in your bedroom and any other room where you spend ample time. There are amazing portable humidifiers (about the size of a water bottle) that help ensure you’re never without a dewy draft.

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I’ve turned into Sasquatch. Why am I so hairy?

Excerpt from Asking for a Pregnant Friend: 101 Answers to Questions Women Are Too Embarrassed to Ask about Pregnancy, Childbirth, and Motherhood

My tummy, upper lip, back, and bum took to growing extra hair (à la an elderly man) during pregnancy. And it wasn’t peach fuzz…it was dark, shockingly long hairs. Eric once caught me mid–tummy shave. Not cute. Unsurprisingly, an increase in hormones are to blame, specifically androgen and, wait for it, wait for it…estrogen! These hormones not only induce hair growth but also prevent hair from shedding. This is a big reason your locks become so lustrous — the hundred or so strands that typically shed each day stay put when you’re growing a baby. An increase in your metabolism and blood circulation also play a part in all this, as they keep the hair pumped up with nutrients. Regarding the darkening of body hair, this is caused by the extra melanin — a pigment that impacts the color of hair, skin, and eyes — your body makes during pregnancy.

Androgens, primarily composed of testosterone and androstenedione, are a main cause of hair growth during pregnancy in places usually reserved for male hair growth. They’ve been nicknamed “male hormones” because — while they’re present in both men and women — men typically have higher levels of them. In the female body, most androgens are converted into estrogens. Androgens were likely to blame for the coarse, curly, and black nipple hair my friend Chelsea reported during her pregnancy. She said she had more of it than her husband. I took her word for it.

In rare cases, excessive body hair can be a sign of hyperandrogenism, which is an overproduction of androgens. This condition can cause high blood pressure, acne, weight loss, and other not-great side effects. If you feel your body hair is out of control, let your care provider know.

What to do

If all the hair really bugs you, go ahead and shave. Hair removal products aren’t recommended, as the chemicals leach into the skin. And while waxing is safe, it usually isn’t advised because hot wax can irritate extra-sensitive pregnant skin. If the hair only kind of irks you, consider making peace with it and saving yourself major time in the shower. You can really make friends with it by rubbing almond or jojoba oil all over after showering, softening the hair and minimizing the development of stretch marks. And take heart in the knowledge that your Sasquatch traits will almost entirely disappear by six months after birth.

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Why does it look like a crimson, white-capped mountain range has sprung up on my face?

Excerpt from Asking for a Pregnant Friend: 101 Answers to Questions Women Are Too Embarrassed to Ask about Pregnancy, Childbirth, and Motherhood

Throughout my pregnancy, topographical maps of the Sierra Nevadas would pop up along my jaw and the edge of my nose. Everest even made an appearance once. I felt like a prepubescent boy. And I’m not alone. Many of the mamas I work with come into childbirth prep classes horrified that the clear, dewy skin they’d worked so hard to maintain had reverted to red, bumpy chaos. The main reason for this is…wait for it… wait for it…you guessed it! Hormones! Increases in the hormone andro- gen can incite acne, as it causes oil glands to become overeager producers.

The good news is that for most women this condition will resolve after childbirth, when androgen levels drop. And hey, girl, throughout it all, remember that you are a gorgeous-baby-making goddess, regardless of what your skin is up to.

What to do

Combat that acne with the following:

  • Be hypervigilant about skin care. Wash with an organic facial cleanser — made specifically for acne — every morning and evening, and after heavy sweating.

  • Avoid washing too often, as this can actually cause more oil to develop.

  • After washing your face, use an organic antiacne toner. You can also make toner with one part raw, unfiltered apple cider vinegar and three parts distilled water. Follow this with an organic moisturizer that doesn’t contain retinol. Some effective moisturizers made specifically for acne include ingredients like raw shea butter, aloe vera, and manuka honey.

  • Wash your hair regularly, and keep it out of your face. Oily hair rubbing on your face could exacerbate acne.

  • Use the speaker feature, or headphones, when talking on your phone, as the screen is often covered in oil and dirt. Cell phones are way grodier than they look.

  • Staying on the theme of keeping gross stuff off your face, wash your pillowcase once or twice a week. On a side note, experts (aka, my grandmother) believe silk pillowcases reduce the development of wrinkles.

  • If the acne is out of control and it’s stressing you out, ask your care provider for a dermatologist referral.

  • While it’s tempting to use medication or chemical-laden treatments, these often aren’t advisable for pregnant women. Many experts also advise against topical treatments containing salicylic acid.

  • Wear makeup only when you feel it’s absolutely necessary. And make sure you’re using oil-free products.

  • Drink plenty of water, and avoid refined sugar and processed foods.

  • And here’s the one that is near impossible for me — do not pop those suckers. While it’s one of the most satisfying feelings in the world, it could leave scars.

Why are there dark spots all over my face?

You have what’s called melasma (aka “the pregnancy mask”), which is caused by an elevation in progesterone that prompts pigmentation levels to increase. This results in dark, discolored patches on the skin, and it’s incredibly common in pregnant women. The good news is, it isn’t accompanied by other symptoms and isn’t dangerous for you or baby. It should fade after childbirth, when progesterone levels drop.

What to do

Check in with your care provider to confirm the patches aren’t a sign of another skin condition. After melasma is diagnosed, apply organic zinc oxide sunscreen every morning, and reapply as needed, as sun exposure can darken the patches. You can also avoid excess sun by becoming a hat lady and using your melasma as an excuse to skip that hike in favor of a cozy book-reading sesh in bed.

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I’ve heard so many women talk about loving their pregnant body, but I can’t stand mine. I can barely look in the mirror, and I feel so unsexy. My body shame is even making me resent my baby. Is there something wrong with me?

Excerpt from Asking for a Pregnant Friend: 101 Answers to Questions Women Are Too Embarrassed to Ask about Pregnancy, Childbirth, and Motherhood

With a culture that has historically valued a flat stomach and slim thighs above all else, it’s so normal for pregnant women to feel uncomfortable and unattractive as their body shifts. Even women who never had body issues can have physical insecurities triggered during pregnancy.

The cause of much of this insecurity is the speed at which the changes are happening. We barely have time to integrate with what’s happening. It’s like, bam! — one morning we wake up and it looks like someone drew a line down our belly with a brown Sharpie. Then bam! — our fingers are too pudgy for our rings and our nose has gotten wider and squishier. And oh look — now our favorite clothes don’t fit, parts of our body we didn’t think would bulge are bulging, and our feet feel like they were injected with Play-Doh. And the changes don’t stop for at least twelve months. I mean, come on! Who wouldn’t be thrown by these almost constant shifts in appearance?

If you’re thinking, “Um, those ladies who are always waxing lyrical about their pregnant bodies don’t seem bothered by the same changes I’m experiencing,” I hear you. But while those I’ve-never-felt-so-radiant wenches (just kidding, I’m just jealous!) probably aren’t lying, I can al- most guarantee they have moments when they look in the mirror and feel a jolt of insecurity when they notice how wide their hips have become or see the fresh stretch marks on their thighs. It can be a shock for anyone — even if they’re not talking about it.

But this shock can feel really big if you, like me, have struggled with body image. When I was in high school, I was convinced that if I were just skinny enough, everything I ever wanted to happen would happen — like my skinny body would be my fairy godmother. So in pursuit of this totally logical dream I would starve, then binge, starve, then binge. After lots of therapy I got it under control and began loving my body (most of the time)…but then I conceived Hudson.

When I began showing, all I could focus on was the spreading and softening of the faint outline of abs I had worked so hard for, and my butt, which had always been a pancake, becoming a lumpy pancake. I felt like the most unsavory pregnant lady in the history of pregnant ladies. This led me to believe Eric would never ever want to have sex with me again. He tried everything to convince me otherwise, but nothing worked. I felt horny (because pregnancy hormones can cause mega-arousal) but didn’t act on it because I was sure my body was incapable of inspiring lust and would probably horrify Eric if he saw it naked.

This all made me feel discouraged and resentful. Especially resentful. I was resentful that my husband got to have a baby without dealing with any physical changes or feeling like he’d lost his sex appeal. I was also resentful that I was giving up what felt like every fiber of my body and desirability for my baby.

While I didn’t feel too bad about resenting my husband (I mean re- ally, why can’t nature make them feel a few contractions?), I hated that the shock of my body changing made me feel even a tinge of resentment against my baby. That I could feel anything but total love for him devas- tated me. So, yeah, a majority of my first trimester was spent in a sexless pit of resentment and guilt. Fun, right?! But mamas, I got out.

Bolstered by the brighter perspective brought on by the body image–enhancing tools of working out, therapy, and the weird stand-naked-in-front-of-a-mirror exercise I outline below, I finally realized that unconditional love for my child can live in harmony with a splash of resentment and a sprinkle of annoyance. Thoughts of our children are not always going to cause hearts to pop out of our eyes — and that’s okay.

You will save yourself a world of self-inflicted emotional torture later down the road by giving yourself grace now for having feelings about your baby that aren’t all rosy. (Of course, if those thoughts turn violent in any way, alert your medical care provider.) If you’re feeling irked that baby’s making your skin ripple with stretch marks and your sexy time turn into “just rub my feet” time, it’s all good. You’re not alone. You’re part of a tribe of strong, radiant, multilayered women also feeling so many feels about their body and baby.

What to do

While training your mind to sprinkle grace over the whole range of emotions about how baby is impacting your body image and sensuality, give yourself physiological support by talking with your care provider about starting (or continuing) an exercise program. Exercise not only strengthens the body for birth but also releases endorphins that elevate your mood and help you see yourself in a more attractive, sexy-time glow. Up the exercise benefits by being active outside, as the combination of fresh air, vitamin D, and movement is magic.

In addition to discovering a movement plan that works for you, try this:

  • Eat mindfully. Think about what you’re eating, as certain foods can exaggerate the anxiety and depression sometimes triggered by body image stressors, while others can enhance your energy and mood. Soda and other high-sugar drinks, pretty much anything with high- fructose corn syrup, white bread, too much coffee, and fried foods are major culprits when it comes to making you feel blah. On the flip side, whole grains; chickpeas; Brazil nuts; eggs; omega-3 fatty acids; foods high in antioxidants, like berries; and probiotic-rich nosh, such as yogurt and kefir, can all help your mind and body smile. Make sure your diet supports any special circumstances you might have by running it by your care provider.
  • Get naked in front of a mirror. Release body shame and up your feelings of sexiness by standing naked in front of a mirror and finding one area of your body that you love. After you find that area (and it can be as small as your lips or a smooth patch of skin at the base of your neck), really focus on it. Allow yourself to fill with thoughts about how beautiful that area is and how appreciative you are that it’s nourished by blood and oxygen and all the other miraculous functions of the body. Each time you do this exercise, find a new area to focus on.

The point is to start training the mind to shift focus from the parts of our body we don’t like — the parts we usually obsess over — and realize that our body is actually covered in beauty. Know that this exercise can feel super uncomfortable in the beginning, as the act of immediately homing in on cellulite or extra padding is ingrained in us. But if you commit to pushing past the discomfort and the inclination to body-shame, you’ll slowly move into a space of adoration for your body that can create a whole new body. Pretty cool!

Seek therapy. For those who have struggled with eating disorders or exercise addiction, pregnancy might reignite old thought patterns. Give yourself the customized emotional nourishment you deserve by finding a therapist you trust and connect with. A good therapist can offer wonderful support for integrating with your changing body and figuring out how to fall in love with it, or at least come to terms with it. They can also help you work through the feelings toward your baby these changes might trigger.

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