20 week ultrasound

I can't believe I never posted this. It's been busy all the time since November, really! We had our 20 week scan in November and baby looked healthy and perfect! This was a change from our last two pregnancies- Maia had what appeared to be an enlarged heart, so we had to have a level 2 ultrasound that dispelled that. And then Kieran's 20 week scan showed an enlarged kidney (hydronephrosis) which did pose a slight problem for him when he was born early. So this time, no worries or anything! Baby #3 is a surprise but we do have a guess as to the sex :)

Exercise in pregnancy.

In my last two pregnancies, I was a lazy oaf. Honestly. Anything I read about the importance of exercise in pregnancy didn't faze me. So I had poor nutrition going for me AND no exercise - lovely! I bet if I had been pregnant in a season OTHER than winter (which is an incredibly long season in Minnesota!) I may have gone on more walks or something. This time around I was determined to exercise because 1, I'm trying to be more heart healthy in general, and 2. of course, there is research on the benefits of exercise for women trying to prevent pre-eclampsia! From the study: "...physical conditioning positively effects key physiological variables that are adversely effected in preeclampsia. If physical conditioning produces similar results in women at risk for preeclampsia, regular physical activity may attenuate the progression of the disease. We hypothesize that three separate but potentially interactive mechanisms could explain a protective effect of prenatal exercise against preeclampsia." [see research study for more information on those three mechanisms.]

I started exercising at home in May with a workout DVD that I really enjoyed. A fitness center is not in our budget, but this worked for me! I was working out almost every day! Summer got busy and I had to cut back a bit. I loved how I could easily fit it into my schedule. I usually worked out while Kieran napped. Maia enjoyed working out with me - and by working out, I mean copying some of the moves for about 5 minutes before declaring her exhaustion and flopping on the couch, ha! This past weekend I was at the Twin Cities Birth & Baby Expo and local yoga studio Blooma was selling their prenatal yoga DVD for $4 off the regular price - yay! I scooped it up!

I've done it once so far this week AND gone on two fast-paced walks! I am so proud of myself this week! In my first trimester I was lucky to get on a walk once a week due to the exhaustion. Now that I'm feeling energized I've been having fun getting out on walks and for the chilly days, I have the prenatal yoga! I also discovered a prenatal yoga class in St. Paul on Sundays that is a donation class, so you can pay what you can. What a great opportunity! I found a friend who might go with me sometimes, so that will be fun! Now the trick is to find a place to do some walking indoors, as winter is fast approaching. I don't think I get up early enough to be a mallwalker!

Recent study findings.

I found an awesome, older study on pre-e this week as well as brand new research coming out and wanted to share both.

The first is a 2008 study done by Yale. I cannot BELIEVE I missed this one! It states that pregnant women who consumed high cocoa-content (dairy-free) dark chocolate decreased their risk for pre-eclampsia! How cool! It has to be 70% cocoa or higher to be dairy free - and it needs to be dairy free because the proteins in the dairy interfere with the antioxidants. So I immediately went out and bought 70% dark chocolate and will now eat a small square of the bar each day, yum!

The second is a study that, to be honest, freaks me the hell out. It's a study that finds that there is potentially a battle going on between the cells in the placenta (something cells from dad help create) and the mother's uterus - and dad's cells have something to do with it. I can't explain it well at ALL, but this article at Science Daily can, and there was also a very easy-to-read/understand article written by the New York Times that came out today. Definitely read both of those links for more information because I just can't do the medical jargon justice :) But from my gist, you can see why it freaks me out a bit, right? This could all be Josh's fault! Ha, poor guy. But the study is helpful. If I get pre-e again, which I do know is a real possibility despite my prevention methods, then maybe I will be at a bit more peace knowing it wasn't all "my" fault. (Not that Josh can control his cells or anything, either, but you know what I mean :P)

16 week midwife visit

Well I finally have a computer back, time for a proper entry. My last entry was done on my iPhone - a bit tedious if you ask me! :)

I realized I never once talked about choosing my midwife. I talked about WHY I chose a homebirth midwife but not why I chose my specific midwife. Silly me! I will fill y'all in right now: So, sometime after I had Kieran I had started to do research on what had happened to me - the pre-e/HELLP, how it can possibly be prevented, etc. I remembered an old boss of mine had had HELLP syndrome with her first baby but not her second, so I decided to ask her what she had changed, if anything. She told me that while pregnant with her second, at 26 weeks, she started to get pre-e signs. She reached out to a local forum about what to do and a midwife replied - she gave her many thoughtful suggestions - change diet, lower stress, high protein, exercise, etc. This woman reports that the suggestions she received helped her turn around that pre-e diagnosis and she went on to deliver with no complications! She saved the whole conversation and copied/pasted it to me in a Facebook message. I never forgot the name of that midwife.

This summer, when Josh and I made the decision that at SOME point we would try for one more, I decided to call around to some local homebirth midwives. I had never done such preemptive planning, it felt great! I spoke with a few midwives about the changes I made, asked if they'd be comfortable taking me, asked about their experience, etc. I did speak to the midwife I referenced earlier and I loved her! So when it came time to interview midwives in my first trimester, she was the first one I scheduled. And, she ended up being the one I picked, without further interviewing? So - why did I pick her without seeing anyone else? Well, in addition to that success story from my former boss, in the interview, my midwife told me about a success story she had. I was hungrily looking for these success stories of people conquering pre-e - there had to be some, right!? Well, she shared with me that one of her clients had birthed 4 babies in a hospital and had had pre-e and gestational diabetes. When she had her 5th child, she sought out this midwife and birthed her baby at home with no pre-e or GD! And she had a 6th child at home as well - again, no complications! I was so awestruck. I knew she'd be able to help support me through this. I also personally knew a woman who had had pre-eclampsia & gestational diabetes with her first child (with a different midwife) and when she hired my midwife for her 2nd and 3rd births, she had no pre-eclampsia OR GD and credits much of her success to a diet and lifestyle changed supported by her midwife. So she came highly recommended from quite a few sources, and I felt comfortable with that from the get-go.

I still love her. She is fantastic. And the appointments, omg - THE BEST. Did you know homebirth midwives meet with you for an HOUR? A full hour! Not 30 minutes in a waiting room and 5 minutes with the doctor...an hour! That gives us lots of time to talk about everything - emotions, physical ailments, challenges or successes with my nutrition...it's so awesome. She and her apprentice really take the time to listen to Josh and I and we love it.

Today we had our 16 week appointment! For the first time, we tried to hear baby through the doppler but baby was WAY too active - just kept hearing my healthy placenta, ha! We'd hear the heartbeat for like, 2 seconds then baby would float away again. Ha! I felt my first two kicks last week! I haven't felt any since but boy oh boy do I feel this baby MOVE. So funny. Next month is our 20 week appointment, then I'll receive a referral to see a private practice perinatologist to do our 20 week ultrasound. He does the ultrasound himself and talks you through what you're seeing - unlike the ultrasounds techs who turn the screen away form you and can't tell you a damn thing, LOL. So we have that to look forward to! (And if I haven't mentioned it before, we are not finding out the sex!)

My herbal infusion.

I didn't know much about herbs before I got pregnant, but I started to do some research about them as part of my overall 'healthy pregnancy' plan. Specifically, I wanted to use some herbs known to promote cardiovascular health and low blood pressure. A friend of mine turned me on to an herbal infusion with the following: skullcap, red raspberry leaf, nettle & dandelion root extract. So what are they all for?

• Skullcap is known to lower blood pressure by keeping arteries open & promotes healthy blood flow.
• Red raspberry leaf is a common pregnancy herb, known to help tone the uterus.
• Nettle aids in lowering blood pressure. (I found out later in my pregnancy that it also aids with keeping blood vessels open, healthy & flowing, and kept my varicose veins at bay!)
• Dandelion root acts as a blood purifier that helps both the kidney & liver remove toxins and poisons from the blood. It is also restorative to the liver.

Below are the pictures of the herbal infusion. Each night I heat up water in a tea pot, pour the water over 1 spoonful of each of the 3 herbs in the mason jar, then I add a bit of agave nectar or honey for sweetness. I put it in the fridge for at least 4 hours. In the morning I strain the herbs, add dandelion root extract and drink the infusion throughout the day! I typically drink it in two servings and it tastes good cold or hot.

The herbs all afloat in the mason jar.

The next day: Herbs ready to be strained, then I add the dandelion root extract!

9 weeks!

It's been awhile since I posted! But, when you only have time to blog after the kids go to bed, and you're hit with first trimester exhaustion to the extreme and go to bed at 10pm every night, well, some things take a backseat. Like my sewing, the house cleaning...and this blog!

Anyways, I'm still here, and I have lots to update on! I am now 9 weeks, due on April 4th, 2011. My dates were just slightly off (turns out I did find out at exactly 4 weeks pregnant, just like with the other 2!) and an ultrasound at 8 weeks confirmed my suspicion. Maia's due date was April 5th, so this baby will be term right when its big sister and big brother celebrate their birthdays...I could very well still have a March baby (again!) Of course I can't get the scanner to work, but the ultrasound was great - saw the healthy heartbeat, little hands & even the spine.

The biggest thing in my life right now? Food. I am constantly controlled by food. I'm always hungry! And always thinking about food. It's exhausting! I have to eat rather constantly to a) get my protein in and b) just to feel okay! But it's going well. I've started drinking a morning smoothie with 3 scoops soy protein powder from Trader Joe's, plus a splash of juice, greek yogurt & some fruit & spinach - that, my friends, is a lovely 50g smoothie! So nice to get that 1/3 out of the way right off the bat. Then I usually follow that up with 2 eggs. It's working really well for me! The rest of the day is spent eating small 'meals', and mostly everything has protein in it, or is paired with something with protein. My body definitely knows it needs protein because that's all I crave! Red meat, yes please! Sweets & sugars and carbs? NO thank you. They are really turning me off, and if I do try some I feel extremely sensitive to them and get a stomachache. I've really turned my diet around to be so sensitive to sugars now!

I have also interviewed midwives & picked one, but I'll post on that separately. She has me taking 1000mg magnesium in addition to my aforementioned supplements, as that's been known to have some help preventing high blood pressure/pre-eclampsia. (See this link for more info.) I am trying to cover ALL bases and make sure I have no deficiencies!

vitamins & supplements

Back when I was pregnant with my other 2, the only thing I took was a prenatal vitamin. Look at me now! Based on my research about different ways to prevent pre-eclampsia, I am taking the following:

• Selenium: based on this study, this study and finally, this one, finding that selenium lowered the incidence of pre-eclampsia.
• Vitamin B12: based on this study finding that B12 deficiency may have a hand in HELLP syndrome.
• Fish oil: I started taking this 3 times a day for heart health before I got pregnant - remember, I used to have high cholesterol! A bonus for me is that it probably has something to do with lowering pre-eclampsia risk, too! This study says that "women with the lowest levels of omega-3 fatty acids were 7.6 times more likely to have had their pregnancies complicated by preeclampsia as compared with those women with the highest levels of omega-3 fatty acids."
• Magnesium (not pictured) I take this to keep my blood pressure low, at my midwife's suggestion. This article discusses why it's an important mineral. I personally take 1/4 tsp. a day of bulk magnesium citrate powder from a local co-op, and I put that in my smoothie. It makes for an effective laxative as well - a bonus in pregnancy! The powder is a purer, more effective form than pills, and I believe you can get it online if you don't have a co-op near you that sells it.  Another way to add magnesium into your life, besides food and supplements? Epsom salt baths!
• Vitamin D: This study is one of many that touches on Vitamin D deficiency being a risk factor for pre-eclampsia. I was tested on May 23rd to have a blood level of 41.7, which, as you can see below, is the lowest acceptable level. This website talks about former and current suggested levels for Vitamin D. My physician must go by the older guidelines because she told me 30-80 was acceptable. In preventing pre-eclampsia, that's not acceptable to me! So I am now taking 400IU from the prenatal + 4000IU, making my total 4400IU a day. According to my research, that should bring my blood levels up from 41.7ng/ml to about 80ng/ml.

Old guidelines for Vitamin D:

Blood levels below 20 ng/ml or 50 nMol/L constitute a serious deficiency

Blood levels above 32 ng/ml or 80 nMol/L had previously been considered acceptable

(I was at 41.7ng/ml in May-acceptable by these older guidelines)

New guidelines for Vitamin D:

Blood levels of 40 ng/ml or 100 nMol/L are now considered the lowest acceptable level - now, 41.7 is way too low!

Blood levels of 60 ng/ml or 150 nMol/L are now considered an optimum level

Blood levels of 80 ng/ml or 200 nMol/L are now considered a safe upper limit -here's where I'm aiming for!

So that's where I'm at so far, at the beginning of the pregnancy before consulting my midwife. These amounts may certainly change and I may add in some more supplements if that's needed.

Choosing a care provider: Part 1

A VERY important component to avoiding pre-eclampsia, in my opinion (and based on the research I've done) is nutrition. Specifically, they're finding that high protein diets during pregnancy help ward off lots of complications. Prior to getting pregnant I was becoming aware of the things with protein in them to get used to it, though I did not keep official track. Starting yesterday I kept track in a journal that I will bring with me everywhere. I wrote down everything I ate for the day - because if it's going in my mouth, it has protein in it! My preliminary goal is 150 mg. Normal pregnancies should shoot for 80mg, and if nursing a toddler it's recommended you up that to 100-ish. But I'm trying to avoid pre-e AND nursing a toddler, so 150mg it is. That number may go even higher if my midwife deems it necessary.

Did you catch that? I didn't say doctor...I said midwife! I bet you'd think someone who has had pre-e twice and HELLP once, resulting a preemie, would automatically be considered high risk, right? I should be talking to a doctor, or a high risk specialist like a MFM doctor. But that's not the route for me this time. Twice now I've pushed aside my desire for a homebirth because of money. But a homebirth is worth more to me than the money we might struggle to come up with to pay for it. See, the Brewer Diet is something I am going to need some support with. I also want and need someone who is able to spend time with me going over my history and coming up with a plan of action for this one, including diet, exercise & herbs (and potentially other things like acupuncture, etc.) Homebirth midwives schedule you for an HOUR appointment! A whole hour, just talking about you and your baby! And thankfully, based on the changes I've made, the homebirth midwives I have interviewed over the phone were comfortable taking me on. They also have great backup doctors who are supportive of homebirth, should the need to transfer arise. I also feel that pre-eclampsia, should it happen to me again, is easily diagnosed by a midwife and there will still be time to transfer. For me, a homebirth midwife is my one shot at a whole, normal, natural pregnancy. Josh supports that 100% because we would rather start off a pregnancy positively, from the beginning, to give my body and baby the best shot at a full-term pregnancy.

So speaking of the midwives...I need to call a few to interview them in person!

Yep...I'm pregnant!

And so it begins, with the pregnancy test...I took one last night and one this morning. Let me tell you, taking a pregnancy test at night before bed is a bad idea if you want to get any sleep! Josh told me he would disregard that one so he could get some sleep, ha - glad it was so easy for him :) The morning test is pictured above.

I had Josh run out to get the tests last night because I had been starving the whole day. Uncharacteristically so. Pregnant, first trimester-type starving. I also flossed my teeth yesterday, and immediately they started bleeding...another tip off! Lo and behold I am 5w4d. That really surprises me - with my other 2 I found out right at 4w!

Why am I blogging about this pregnancy, you might wonder? Well, I have had complications in my 2 previous pregnancies that finally compelled me to make drastic life changes after my second baby was born 10 weeks early. Maia was born 3 weeks early at 37w, as I had mild pre-eclampsia. Kieran was born at 29w5d because I had pre-eclampsia that turned into HELLP syndrome....these complications are enough to make some women choose not to have any more children. But I never felt done. And I felt I needed to give it one more shot. However, to do so without changing some habits would be completely irresponsible and selfish of me, not to mention unsafe to myself and the baby. The habits I speak of include extremely poor eating - I had very little regard for nutrition while pregnant or not pregnant. I drank lots of pop, ate lots of candy, and ate too little veggies. Sugar consumed my diet as did carbs upon carbs upon carbs. I didn't know how much the food you put in your body impacts your well-being. I had high cholesterol at age 22! That is just ridiculous. That should have been my first clue. But after Maia arrived safely, with a smooth vaginal induction, I brushed the pre-e aside and figured my chances of acquiring it were rare, as the statistics say it is.

However, that was not the case. I got pregnant with Kieran just a few weeks before our wedding - I was 7 weeks pregnant the day we got married. To say that's not the best way to start out a pregnancy is an understatement - high-stress, little sleep and food intake, and, oh yeah, I had an 18 month old toddler going through a sleep regression - whew! Once the wedding was over I collapsed on the couch for weeks. I continued to eat whatever I felt like, keeping track of nothing. Starting my day out with a bowl of cereal, juice & fruit - can you say carbaholic? I should also mention I was still nursing my toddler. I know that I was not taking in enough protein for me, much less for my pregnant, nursing body. I suspect my Vit D levels were low as well...this all added up to a pre-e diagnosis at 28 weeks and bedrest, which was quickly interrupted by the HELLP symptoms which sent me to the hospital. My son arrived over 10 weeks early at 2lb10oz and stayed in the NICU 53 days. It was an experience that traumatized me in many ways, but also gave me strength. My son taught me so many things...

And one of those things, is that it's never too late to change your life. After I had Kieran I started to pay attention to my nutrition intake. I ate high protein, low-carb and if I did have a carb, I balanced it with a protein. I felt great! Then I started exercising! I went to birth trauma therapy...it was a great start to my year, filled with positive changes for the better. My goal was to be heart healthy whether we decided to have a third baby or not. I had to change my life - and I did!

I'll leave it here for now. So many things to write about, so many things to think about. I am positive and hopeful. Well-researched and well-informed. And I'm pregnant...so it's too late to back out now! I'm so excited for this chapter - our third and final baby. Finally, things are going to be different.