Pumpkin Chili

Pumpkin Chili Recipe: 

Ingredients: 

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3 Cups Roasted Pie Pumpkin (roast in the oven until soft) 
1 lb Ground Meat (we used Turkey for the party, but I also use beef) 
*Sub 2 15 oz cans of beans for veggie Chili* 
1 cups (or to taste) Green Chilies (if it is Chili season, so get some freshly roasted green chilies. If it is off season, you can usually get Poblanos at the grocery store or canned/ frozen. 
1 Onion
1 T Chili Powder mix (We used a mix from Natural Grocers, it has Chili Pepper, Cumin Seed, Oregano Leaf, and garlic. You can use this or the separate spices) 
1 T Smoked Paprika
4 Cups or more Broth (veggie, store bought or homemade Nutritional Broth
Pepper
Salt to taste

Instructions: 

1) Roast Pumpkin, peel, and chop roughly
2) Cook Meat, onions, salt and spices until meat is cooked. Use the pot you will be cooking the chili in. 
3) Add garlic and green chilies, cook until combined. 
4) Add pumpkin, cook until combined. 
5) Add broth. (The amount of broth here can vary, 4 Cups will make this more strew-like, and more broth will make it more soupy.) 
6) Let the soup simmer on low until Pumpkin is soft and become more integrated into soup. 

Nutritional Fall Broth

Nutritional Fall Broth: 

I have been using a pressure cooker to make my bone broth this year and it is amazing! Saves time, and gas/ electricity. I have also been adding nutritional herbs to cook with the bones and veggies. I have mostly used nervines and immune booster, but anything would work. It doesn't affect the taste much, but adds more complexity. 
*if pregnant, be mindful and contact your midwife to know what herbs are safe for pregnancy*


Ingredients: 

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Organic Bones (Baked at 450 for 20 min) 
2 Carrots (chopped roughly) 
1 Head of Celery (chopped roughly) 
1 onion (chopped roughly) 
1 Leek (chopped roughly) 
4 Garlic Cloves
1 bunch of Parsley
1 T Red Boat Fish Sauce
Splash of Apple Cider Vinegar
Salt to taste

Herbs: 
2 Bay Leaves
1/4 Cup Elderberry
1 TRosemary
1 T Peppercorn
Astragalus (a few slices) 
1/4 Cup Nettles
Reishi (a few mushrooms) 
1/4 Cup Lemon Balm
1/4 Cup Burdock
1 T Turmeric
1/2 Cup Alaria (or other seaweed) 
1 T Codonopsis
Other herbs specific to your needs... 

Put all of the above ingredients into the pressure cooker. Cover the bones and veggies with water, make sure to not fill more than the "fill line." Cook in pressure cooker for 30- 60 minutes. When warm, but not hot, strain broth.  

An Inspiring Celebration and Global Call for More Midwives

An Inspiring Celebration and Global Call for More Midwives

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In late June, I had the honor of attending the 31st Triennial Congress of the International Confederation of Midwives (ICM), in Toronto, Canada. The theme was, “Midwives---Making a Difference in the World”. I’d heard rumors that more than a 1000 midwives attended these events, but as I arrived at the Toronto Convention Center on the first day, the numbers didn’t look like they’d add up. Helpful ushers guided the us down escalators to the meeting rooms below......far below, it turned out. There are at least four levels of conference facilities below ground level. As the escalators delivered us 3 levels down, the noise of a crowd became louder and louder. A colorful, diverse, mass of people soon came into view. Midwives from more than 100 countries filled a vast lobby. They held flags from their countries and many dressed in traditional costume, and waited for the Opening Ceremony doors to open. They spoke the languages of Africa, Asia, the Americas, and beyond. The excitement and anticipation was palpable.

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The doors soon opened to a massive room, with seats for thousands; more than 4,000 it turned out. Many midwives sat with colleagues from their countries, hundreds from New Zealand, UK, USA, Canada, Japan, Korea, Kenya, Mali, France, Italy, Philippines, Indonesia, and many more. The conference was opened by Ontario Regional Chief, Isadore Day, from Serpent River First Nation, Ontario. Chief Day spoke with eloquence and humor, and deep reverence for his heritage and Mother Earth. A fitting way to kick off a conference focusing on maternal and neonatal health, through the care of midwives.

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For the next two hours, we were honored to be entertained by many incredible talents, including Midwife Alison Walker, who beautifully sang the Canadian National Anthem (in French and English!); Tekaronhiáhkhwa Santee Smith, a leader in indigenous performance and dance; Ms. Abelone Melesse a 21(!) year old rapper who is the National UNICEF Ambassador to Ethiopia; two Inuit Throat Singers; Lisa Odjig-Hoop Dancer, who has danced before Queen Elizabeth, using up to 17 hoops at a time; Jade’s Hip Hop Academy dancers (amazing) and fantastic fiddler/step-dancer Stephanie Cadman. Perhaps the most moving part of the afternoon was the parade of nations, where a representative from each country carried their flag in procession, placing them on the stage, creating a colorful backdrop for the week. Optimism filled the room; we know there’s so much work to be done, but the connections and friendships made during this week will turn into positive action, benefitting pregnant people, their families and communities world-wide.

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The following four days offered an overwhelming schedule of provocative scientific presentations and skills workshops. Topics ranged from access to ultrasound in developing countries, to leadership development, to preserving vaginal breech skills, to building cultural understanding, to increasing access to VBAC, to LGBTQ & trans people’s health care, to abortion access, and hundreds more. The plenary sessions focused on the promising impact that midwifery care has had, and will have, on the health of refugees, indigenous and aboriginal people, and other vulnerable communities around the world.

A highlight of the week was a presentation by Ms. Kate Gilmore, Deputy High Commissioner for Human Rights of the United Nations. She discussed the role of midwives in increasing humanity & compassion in the world, as well as the connection between human rights and midwifery care. It was one of the most powerful speeches I’ve heard.

Make your plans now for the 32nd ICM, which will be in Bali, Indonesia, in 2020. It promises to be another inspiring, powerful event and there’s so much to learn!

Lauri Hughes, CPM, RM, CLC
August, 2017

Our Story

We are honored to introduce ourselves as the four midwives of Community Roots Midwife Collective (CRMC). We are a group of dedicated, trained midwives providing home birth midwifery services to those in or near Boulder County. Central to our mission is to provide skilled midwifery care to anyone who desires it, regardless of their ability to pay. Our collective holds the values of integrity, human rights, reproductive justice and physiologic birth paramount.

As individuals, our backgrounds and experience are varied, and we come together offering heart-centered, competent care. Together, we come from a line of elders and teachers who span from Montana, Colorado, Utah, New Mexico, Texas, Mexico, Guatemala, Indonesia, and the Philippines. Midwifery is an ancient art form, rich in wisdom and tradition.

We invite everyone to re-member the purpose and power of childbirth. Concepts which come to our minds are: Evolution. Reproduction. Human Nature. Temporality. Connectedness. Humility. Empowerment.

Birth is fundamental to our survival.  When people are able and willing to connect to this mysterious and impactful process in a way that feels authentic to them, they are given the opportunity to understand and model inner strength, courage, deep wisdom, self reliance and self respect. It can be understood then, that the way in which we acknowledge and approach health care during pregnancy and birth, will have a profound effect on our entire society.

In our current culture, Americans generally approach childbearing as a medicalized process in need of expert management, often met with interventions and fear. The US spends more on maternity care and obstetric technology than any other industrialized country, yet we rank last or near the bottom when it comes to outcomes (cesarean rate, maternal mortality/morbidity, preterm labor, premature birth, perinatal and infant mortality/morbidity, and postpartum depression). Important to note, our poor, immigrant, and communities of color are those which experience the highest rates of complications. Statewide data for Colorado looks very similar to the national averages for these outcomes.

In contrast, countries which make space for the natural process of birth, limit interventions, andwhere midwives attend the majority of births have better outcomes (ie Finland, Iceland, Norway, Belgium, Germany, Denmark, Sweden, the Netherlands, and the UK). The Midwives Model of Care is based on the fact that pregnancy and birth are normal life processes. The application of this woman-centered model of care has been proven to reduce the incidence of birth injury, trauma, and cesarean section (CFM). Here in Boulder county, about 9% of all births are attended by certified nurse midwives (CNMs) and about 3% are attended by certified professional midwives (CPMs)/Registered Midwives, such as our practice.

Why Midwives and Home Birth?

Research from the Midwives Alliance of North America (MANA) statistics program (which we are a part of) has collected and analyzed 17,000 cases in which the pregnant person was planning a home birth from 2004-2009.

The data states:

- 89.1% of planned home births occurred at home

- 93.6% vaginal birth

- 87% vaginal births after cesarean (vbac) were successful

- 97.7% of babies breastfeeding at 6 weeks postpartum

- Fewer than 5% of the births used Pitocin or epidural

- Low intrapartum and neonatal fetal death rate overall:

-2.06 per 1000 intended home births (includes all births) 

-1.61 per 1000 intended home births excluding breech, vbac, twins, gestational diabetes, and preeclampsia.

-Low rate of low APGAR scores

These statistics prove that for low risk people, home birth is a safe and healthy choice to make. It also proves that when people become higher risk, midwives know when to transport in order to access the medical options that the pregnant person or baby needs.

Beyond the statistics here are more reasons for midwife-lead care and home birth:

- You cultivate a meaningful relationship with your care providers

- You have the best chance at breastfeeding (midwives see the new family at least 4 times in   the first week to help with the transition into parenthood)

- You have the best chance at having a vbac

- The family is in the comfort of their home

- You participate in informed choice and shared decision making

- You are in control of who attends your birth and catches your baby

- Water birth is supported

- Birthing in the position you choose

- Moving, eating and drinking are encouraged during your labor and birth. 

- Midwives spend time getting to know the pregnant person and their family

- Compassionate and heart centered care

- Lower risk of intervention

- Gentle newborn care

- Personal empowerment

You may be asking, what does midwifery care look like, and what makes it unique from routine OB care? As inspired by the International Confederation of Midwives: Midwifery care is holistic in nature, grounded in an understanding of the social, emotional, cultural, spiritual, psychological, and physical experiences of all humans. Ethical and competent midwifery care  is informed and guided by formal and continuous education, scientific research, and application of  evidence. Midwifery care is provided to clients on the basis of shared decision making and informed consent to all treatments.

Midwives follow a standard prenatal care schedule, and our appointments are an hour long. We provide continuous hands on support through labor and delivery and then keep a close eye on the new family postpartum by offering in-home visits on days 1, 3, 7, 14, and 2 clinic visits at 4 & 6 weeks. Our extensive postpartum care is one of the most beautiful and impactful aspects of midwifery; our clients are able to be in their own home healing, resting and nesting, with comprehensive lactation, newborn, and parenting support.

As midwives of your community, we see it as our responsibility to increase accessibility to our care, educate the community regarding their birthing options, and promote an attitude of trust and respect for the birthing process. Despite the encouraging statistics of midwife-led care, cost remains a huge barrier for many. Though midwifery services cost a fraction of standard OB care ($4K vs $10-$16K), insurance reimbursement for Registered Midwives is very limited, and coverage by Medicaid is non-existent for Registered Midwives in Colorado. 

As you can imagine, poor, immigrant, and communities of color are those who have the least access to our care. And those are likely the communities which could greatly benefit from the comprehensive care of a midwife.

To increase access and educate our community, here’s what we’re up to at Community Roots. Currently, we are offering care on a sliding scale by providing 2 low-cost births/month to those in need. We hold bi-monthly community presentations regarding midwifery care and are present at community events such as Longmont’s Cinco De Mayo, Boulder/Longmont Pridefest, and Longmont Farmers Markets, spreading the word about midwifery care. We offer free, weekly lactation support groups at our classroom space in Longmont and we also teach low-cost childbirth education and breastfeeding classes quarterly.

We are committed to strengthening our local midwifery community. This past July we hosted a training for birth workers about providing culturally competent care for the LGBTQ community and we hope to continue hosting educational events such as this. Also, we recently hosted a screening of the film, “Why Not Home: The Surprising Birth Choices of Doctors and Nurses." The proceeds of this event were donated to the Colorado Midwives Association.

Our goals for the near future include: 
- training midwives who represent under-served communities
-increasing the depth of our sliding scale
-hosting community clinics in which folks can access both midwifery care as well as reproductive health care and holistic therapies such as acupuncture, massage, and chiropractic care for a minimal fee
-AND deepening the scope of our community education by hosting informational presentations at community centers and health clinics, with a focus on reaching out to our immigrant and teen populations.

A story from our midwife Lo:

"I’d like to leave you with a personal story of mine in which midwifery care greatly helped an immigrant family. A few years back, I was working as a medical assistant in a community health clinic in Boulder. There, I met a young woman Silvia from El Salvador, who was newly pregnant. Through our check-ins at her PN appointments, Silvia grew to trust me and was drawn to my midwifery insight. She began to confide in me that she was not feeling comfortable with the MD who was in charge of her care. There was a huge language barrier as the MD didn’t speak Spanish (I trained and practiced in many Spanish speaking countries/populations, so I was able to communicate with her clearly). She didn’t feel that she was in charge of her care. She felt uncomfortable that she only had 15 minute appointments and that she didn’t understand much of the information/choices presented to her. She didn’t feel her cultural practices and beliefs were being respected in the clinical setting. She was afraid of having an unnecessary C/S (at that time, the C/S rate at Boulder Community Hospital was 32%, well above the ideal rate of 10-15% as established by the World Health Organization (WHO). Luckily it has lowered to 26%), and her husband was nervous to be in a hospital setting as he didn’t speak any English. I explained more to her about what midwifery care looked like including informed decision making and hour-long prenatals, and what her birthing options could look like at home. The more we chatted, the more Silvia wanted to birth at home. She was healthy, had a low-risk pregnancy, and was a great candidate. There was one major barrier for them, however, in that they were insured by Medicaid and none of my services would be covered. I chose to offer her my services for $250. I knew she wanted to contribute something, but that she had very little to give. We started care at 28 weeks and spent many hours together, along with her husband, learning about what was important for them to feel safe birthing in the home setting. Silvia went on to have a beautiful, uncomplicated birth at home. She was able to move freely and eat in labor, which were very important to her. She and her husband felt heard and supported. They felt comfortable saying traditional prayers to their baby in the intimate first moments, and we followed  traditional postpartum practices that Silvia knew about from her Grandmother. I continue to be in touch with this dear family and have witnessed them grow into proud and courageous parents. The three of us often reflect that the wisdom they gained through the birthing process birthed them into empowered parents."

In the interest of sustainability of midwifery as a profession as well as CRMC, it would be impossible for us to continue attending births for $250. However, it shouldn’t be impossible for healthy, low-risk individuals to access the care of a midwife if they so choose. That is why we’re here today, asking for your support of our collective, so that we can continue educating our community about their birthing options as well as finding a sustainable way to increase access to midwifery care. Many thanks for your attention and for your commitment to improving our community in all the ways you do. We are incredibly grateful! Please take a peek at our website to learn more about us!

How you can help:

- Donate to our fundraiser now to help us care for our community. 

- Educate your community about home birth and midwives.

- Educate yourself about the health disparities that are in our country and your backyard. 

- Refer people to our Meet the Midwife gatherings, our breastfeeding classes, and our other events. 

- Stay informed about local politics regarding midwives and reproductive justice issues. 

 

Special thanks to Monet Nichole for making our video and providing all of your support.

Racial Issues and Birth

Racial Disparities in Birth Outcomes and Racial Discrimination as an Independent Risk Factor Affecting Maternal, Infant, and Child Health

Despite widespread calls to reduce the infant mortality, preterm birth, and low birthweight rates in the United States, racial disparities in birth outcomes persist, with African-American infants remaining the most vulnerable. In 2013, the rate of preterm birth for African-American infants was nearly double that for white infants.

Known medical, genetic, and/or sociodemographic factors alone do not account for these disparities, leading researchers to examine race and the experience of racial discrimination as independent risk factors for affecting maternal, infant, and child health.

Elephant Circle, in collaboration with the International Center for Traditional Childbearing, the International Cesarean Awareness Network, and the Midwives Alliance of North American has created this Executive Summary of existing research to make this important area of study more accessible to people interested in maternal health.

The Executive Summary includes statistical data to describe the racial disparities in birth outcomes, including preterm birth, low birthweight, and infant mortality; provides a summary of current research to examine the correlations between race, racism, and poor birth outcomes; and provides recommendations to policymakers and researchers so that meaningful strides can be made toward dismantling racism, a necessary strategy to improve birth outcomes and eliminate healthcare disparities in the United States.

The Infographic also provides a useful tool for raising awareness about this important issue. If you have any questions about these tools or the research, don't hesitate to reach out at elephantcircle@gmail.com.

Bring on the Flavor!

by Lo Kawulok, Midwife, CLC

Positive aspects of a varied diet during pregnancy and breastfeeding

One of the best ways we can expose our children to a variety of healthy foods is by eating them during pregnancy as well as while breastfeeding. Julie Mennella, a biopsychologist at Monell Chemical Senses Center in Philidellphia, has been one of the leading researchers investigating the effect of early exposures on the development of taste. Since 1991, she has published a range of studies from the affects of maternal garlic intake on breast milk flavor to prenatal and postnatal exposures of a flavor enhancing an infants’ enjoyment of that flavor in solid foods later on.  

Her work has confirmed what many of us have intuitively known for generations: If we expose our little ones to a balanced diet rich in fruits, vegetables, and complex flavors during pregnancy and breastfeeding, they are more likely to have a taste for these foods later on. And, because we know that a balanced diet is one of the best ways to lower our risks of chronic health conditions such as obesity, diabetes and cancer, the benefits of introducing these flavors to our children while in the womb and during breastfeeding are immense.

It’s really an impressive design: during pregnancy, what you eat is broken down and enters your bloodstream as molecules of protein, carbohydrate, fat, as well as volatiles, which contain the scents from your food. These scents directly affect the taste of food. Amniotic fluid is exclusively influenced by what is in your blood, thus, the flavor of foods you eat are transmitted through the amniotic fluid, which the baby is swallowing throughout pregnancy. The same is true while breastfeeding; the flavors you eat while nursing enter breast milk through the blood vessels that supply the mammary glands that produce milk. Consequently, the more variety in your diet both while growing your baby on the inside and out, the more likely your baby will have a varied palate as they grow.

I love reminding pregnant and nursing folks of this connection because it helps ease one’s mind when trying to figure out what the ideal diet is for both pregnancy and nursing. Because babies are acculturated to flavors in the womb, one can rest assured that they don’t need to limit their diet (unless there is a serious allergy) once they are nursing. I encourage breastfeeding parents to eat the foods that are part of their food culture, be it spicy or highly aromatic, as babies will most likely enjoy these interesting and familiar flavors. Dr. Menella says it well: “A diet of the healthy foods a mother enjoys is modeling at its best. The baby only learns if the mother eats the foods.”

Wishing you all healthful and inspired meals throughout pregnancy, breastfeeding, and family dinnertime!

Longmont midwife collective works to make home births affordable for low-income women

A relatively new midwife collective in Longmont has started a unique pricing model and fundraiser to help women who couldn't usually afford their services access home births.

The Community Roots Midwife Collective comprises four midwives who have been working separately for several years in Boulder County — Rachel Engel, Lauri Hughes, Nichole Didelot and Lo Kawulok.

A year ago, they got together and formed the collective. They took on their first clients in February and, in September, the collective helped welcome five new babies to the world.

In late November, the collective launched their Generosity Campaign, a fundraiser to benefit their Birth Service Fund. The Birth Service Fund allows the collective to fund about two low-cost births per month in order to allow lower-income families to access their services. Anyone can donate to the fund at bit.ly/2idZrAO.

They said they feel that access to midwifery services and home births rather than the modern alternative of a hospital birth is important.

"Some people say midwifery is preventative care in a sense because it is so comprehensive and we spend a lot of time with our clients," Kawulok said. "We take care of every aspect of their health care from their physical needs but their mental, emotional and spiritual needs as well."

A midwife is different from a doula. Midwives are vetted and certified by the state and function as primary care providers throughout a pregnancy. Doulas, on the other hand, function more as birthing coaches and not as medical professionals.

Low-risk pregnancies where the woman feels most comfortable at home are ideal for midwife births, the midwives all agreed. If there are any complications in the birth, the woman's midwife accompanies her to the hospital.

The midwives also check in on their clients several times postpartum to make sure the health of the mother and the infant are on track and answer any question the woman has about lactation or postpartum care.

Kawulok said that checking in with new mothers shortly after they give birth lowers the risk for postpartum depression, making the surrounding community at-large healthier as well.

"Their well-being post-birth and their ability to care for their babies directly affects their children, their families and all of our communities, which is why we believe that every mom, or every birthing person really deserves individual care and the care of a midwife if possible," Kawulok said.

The collective also hosts events such as lactation circles and new mom socials to ward off the isolation that can affect some new mothers.

"If moms are held in those first couple of weeks and they aren't stretched beyond what they can do and they have people checking in on them frequently and caring about them, they have a continuity of care and a lower risk for postpartum depression," Didelot said.

Hughes said it really helps to create a sense of community and support among the new moms.

"People don't feel so isolated because they know they have other parents they can talk to and they're not alone with the experience that they're having at home with their newborn," Hughes said.

Because midwife care is paid for up front and often not covered by health insurance, the collective operates on a sliding pay scale for services.

The sliding scale is unique in that it doesn't require any tax documents or proof of income, but rather functions on the honor system and women's self-evaluation of their resources. It's a much larger version of the "take a penny, leave a penny" bowls on some cashiers' counters, Hughes confirmed.

The sliding scale information sheet asks women to think about their resources. Are they living paycheck to paycheck? Would paying a higher amount mean they aren't able to pay utility bills or that they would have to cut back on eating out and buying coffee?

The lowest end of the sliding scale is $2,500 and the information sheet asks people to exhaust other resources such as friends and family before committing to pay the lowest price. Currently, the collective can only afford to offer two $2,500 births per month on a first-come, first-serve basis.

The midrange on the sliding scale is about $4,000 and is for people who have a steady income and are not worried about meeting basic needs such as food, shelter or medical care.

The high end of the sliding scale ranges from $4,500 to $6,000 and is for people who own property or have savings. Women who pay the higher end of the sliding scale enable the collective to offer the lower end.

Didelot said that the midwives have been amazed that women are perfectly willing to pay the higher end of the scale in order to allow others to pay the lower price.

"We've had two of our current clients pay above the $6,000 rate in order to pay into the fundraiser so other clients can pay at the lower end of the sliding scale and we just think that's really remarkable that those with more resources are willing to do that," Didelot said. "It's mind-boggling. I'm like, 'Oh my God! People are really choosing it!'"

Hughes said that the collective is also passionate about reaching out to traditionally underserved communities, such as people who only speak Spanish or people in the LGBTQ community.

One way to do that is take on apprentice midwives from underserved communities, Hughes said.

Kawulok added that diverse midwives are important because someone with a language barrier or from the LGTBQ community will be most comfortable with someone who can represent them.

"We want people to feel comfortable with who is providing their care and also really be able to educate from the ground up in those communities about their options," Kawulok said.

Karen Antonacci: 303-684-5226, antonaccik@times-call.com or twitter.com/ktonacci

See Full Article Here:
http://www.denverpost.com/2017/01/03/longmont-colorado-midwife-collective/

Depression in Pregnancy: 10 Things You Can Try Instead of Medication

Updated January 20, 2016 (article by Aviva Romm MD)

You’re full of new life! Overjoyed, right?

Actually, if you’re among the 1 in 10 – or even more – pregnant women who struggle with the symptoms of depression, then you might not be feeling overjoyed at all. While you may be happy to be pregnant, this may be overshadowed by cloudy feelings…

I know it can be really tough to admit we’re depressed when everyone else thinks we should be ecstatic. Many women have told me they fear they will be judged by others as “bad moms” for admitting they feel miserable.  And it can be terrifying to imagine taking care of a baby when you feel you can barely get a smile on for the day.

You may also feel very alone with your concerns.

Your midwife or doctor, and even your friends and family, might not recognize that you’re depressed. Your symptoms may be mistaken as simply normal changes of pregnancy due to hormonal shifts and other physiologic changes. After all, fatigue, changes in eating habits, sleep problems, general aches and pains, changes in mood, irritability, and tearfulness – all of these are normal during pregnancy, right?

The answer is sometimes, but not always. When mild and infrequent, these symptoms may be normal, but they are also classic signs of depression! 

Why Do I Feel So Blue? Causes of Pregnancy Depression

The root causes of depression are often complex – but they can be tackled! 

As you can see from the diagram below, depression has many possible causes and sometimes even more than one. These can include:

  • Medical problems (for example, hypothyroidism, severe nausea and vomiting in pregnancy, or a pregnancy-related medical problem)
  • A previously complicated pregnancy or pregnancy loss
  • Nutritional deficiencies (protein, omega-3 fats, iron, vitamin D, to name a few)
  • Fatigue from poor sleep
  • Blood sugar problems, including both hypoglycemia and elevated blood sugar
  • Lack of support or relationship problems
  • Family history of depression
  • Inadequate or ineffective coping skills
  • Stressful life problems (money, living situation, job stress)
  • Unhappiness or ambivalence about being pregnant
  • Food sensitivities  or  gut dysbiosis (unhealthy changes in the gut flora or microbiome)
  • Lack of exercise/movement
  • Lack of sunlight or time in nature
  • Environmental toxins, for example, heavy metal toxicity, usually from eating too much high mercury fish such as tuna, or hormone mimicking chemicals such as plastics from food packaging and water bottles, to name a few sources

Does Depression Pose Increased Risks to My Baby?

Untreated, severe depression can increase some risks to you and your baby – that’s why it’s so important to promptly get the support and the treatments that work best for you.

Even moderate depression can impair your quality of life.

Problems can arise because when we’re depressed, we don’t tend to take optimal care of ourselves. If this happens during pregnancy women are more likely to:

  • Skimp on nutrition
  • Not gain enough weight
  • Have sleep problems
  • Skip prenatal visits
  • Use harmful substances (i.e., tobacco, alcohol, or drugs)

This can increase the risk of premature birth, having a low birth weight baby, medical problems in the pregnancy, and problems at birth.

Increasing numbers of studies are also showing that depression, stress, and anxiety in the pregnant mom influences and alters the expression of the baby’s genes, increasing the child’s lifetime risk of mental health problems.

Prenatal depression also increases the risk of postpartum depression, which, if untreated, can lead to developmental, behavioral, and mental health problems in the baby, as well as problems that arise from neglect if mom is unable to fully care for the baby.

On top of it, all of this can also have an impact on your self-esteem and confidence as a new mom, and this can also negatively affect your parenting.

But not to worry – there is help!

Should I Take an Antidepressant?

Whether to take an antidepressant is a complex and often tough decision. The evidence on the safety of these medications in pregnancy does show some risk of potential birth defects, and also withdrawal symptoms in baby after birth. You have to weight the potential benefit to you and the baby against medical risks of  taking antidepressants in pregnancy. I address this thoroughly in Depression in Pregnancy: Should You Take Medications?.

For mild to moderate depression, natural approaches can be tried first, and are often all that is needed, but women should also consider being under the care of a midwife or obstetrician and a mental health provider simultaneously.

Women with moderate to severe depression, in addition to trying these 10 tips, should be under the care of a physician who specializes in prenatal depression. Medications are an option that should be considered in severe cases, or in moderate-severe cases where your health is at risk because you aren’t able to take care of yourself; but in moderate-severe cases one can often try natural treatment for a few weeks first .

 

  

“The new medicine for women” as I call my whole women approach to Functional Medicine, includes the best combination of available strategies for individual women, used with wisdom and common sense.

 

So What Can I Do? 10 Strategies for Beating Depression Naturally

Here are 10 pregnancy-safe, positive steps you can take toward optimizing your mood and your wellness.

1. Get Real About How You Feel

The first step toward feeling better is to get real about how you feel. If you’re not happy, if you’re feeling sad, or worse than this – feeling desperate – don’t pretend otherwise. The consequences of ignoring depression in pregnancy are serious for you and baby. Admit how you’re feeling to yourself, let your partner, a close relative, or BFF know, tell your care provider and get the ball rolling on feeling better. You’re not alone, there is help, and you deserve wellness!

2. Get a Medical AOK
A number of medical conditions, including thyroid problems, diabetes, hypoglycemia, and anemia can cause symptoms of depression. Have your doctor or midwife run some simple blood tests to check for these and start appropriate treatment as necessary.

Many women who experienced severe nausea and vomiting in pregnancy also report depression – sometimes just because they felt so awful and thought it would never end, other times likely because underlying nutritional issues led to or resulted from the vomiting. Get with your midwife, doctor, or a functional medicine physician who specializes in prenatal care to help you get your nutrition on track.

3. Seek Support, Stay Connected, and Pay for Help if Needed
This is not a time to be shy asking your partner, other adult family members, your BFF, or other moms you know for support, particularly if you already have young children and are experiencing depression. If you are single or if everyone else is too busy to help when you need it, hire some extra help – whether for getting shopping and chores done, or taking care of the house or older kids. This will give you time to take care of yourself – and it’s so important!

Find a therapist. Cognitive Behavioral Therapy is one form of therapy that is especially helpful in developing coping skills for depression, and changing old, ineffective thinking patterns into new and successful skills for coping with challenging emotions, behaviors, and thoughts.

Get educated and clear out the fears. Interestingly, a recent study showed that fear of birth is associated with the later development of postpartum depression. While this association has not been studied in pregnancy, it does make sense that unresolved fears and worries can lead to prenatal depression. I once had a patient who was terrified that, because she’d had an abortion as a young adult some 15 years earlier, she would be “punished by God in this pregnancy,” and that her baby would be born deformed. This fear was even playing out in her dreams, causing her to be fatigued on top of the worry! When I was able to elicit the story and her fears, we were able to do some emotional healing around the issue and she once again had peace of mind and peaceful sleep.

4. Optimize your Diet

Gluten and dairy, while we might crave them like crazy during pregnancy, can cause mood problems in those who are sensitive. A trial of gluten and dairy free for a month, even, might shed light on whether these are not optimal for you. If symptoms improve, stay clear of them; if you don’t notice a difference, it might not have been a long enough trial, or you might not be intolerant of these substances. If you do go dairy free, make sure to get calcium from other sources.

Hypoglycemia is common during pregnancy, often made worse by nausea in the first trimester. It is important to eat high quality foods, especially a protein source (nuts, nut butters, meat, fish, or poultry, hummus or something with beans or legumes, or a protein shake, for example) and good quality fats (avocado and nut butters, for example) every few hours, and never skip meals. You do not have to eat larger quantities, but keeping your blood sugar steady is especially important if you struggle with mood swings or depression. High blood sugar over time leads to gestational diabetes, but can also lead to generalized inflammation in the body, and the chemicals produced during an inflammatory response also depress the mood. So make sure to avoid simple carbs (white flour products, white rice, pasta) and sugar, and emphasize a pregnancy-smart way of eating.

Also, make sure that you are getting all of the nutrients you need. Iron deficiency anemia, low vitamin D, low vitamin B12, can all increase depression in pregnancy, and are easily to supplement. Talk with your midwife or doctor about testing.

5. Get a Move On: Yoga and Exercise Really Help!
30 minutes per day of exercise has been shown to prevent and help with depression in pregnancy. One 12-week study done at the University of Michigan, found that group yoga classes in pregnancy substantially reduced depression, increased mindfulness, and improved mother-child bonding after the birth!

6. See The Light
Bright light therapy can be helpful in brightening your mood. The usual dose is up to 10,000 lx for 30–60 min/day using a light box. One side effect is a slightly “hyper” mood – use for a shorter duration or every other day if you experience this. Even just sitting with your face toward a sunny window for 30 minutes each morning has been shown to improve mood.

7. Sleep Well … and Embrace the “Cat Nap” 
We don’t need to be rocket scientists to know that lack of sleep increases depression and irritability, makes us grab for quick sugary foods that later lead to a blood sugar crash, and generally rocks our boat. It also increases inflammation so our health takes some hits when sleep is poor. Since pregnancy naturally makes it harder to sleep due to our growing belly size and frequent need to pee in the night, taking cat naps in the day rather than pushing through or grabbing for sweets or caffeine is the healthy way to catch up on rest and nip depression in the bud.

8. Spend Some Time in Nature
It’s so easy to spend most of our time indoors and to forget how uplifting even a little bit of fresh air and sunshine can be. But getting even 15 minutes of fresh air each day can help us overcome the nature deficit disorder most of us suffer from, and with it, brighten our moods. Consider a brisk walk for the double benefit of fresh air and exercise for a better mood and even better sleep, or find a sunny spot for a quick mediation to brighten your day!

9. Use these Pregnancy-Safe Herbs and Supplements to Reduce Inflammation and Support Your Brain and Nervous System

  • Omega-3 fatty acids: There is good evidence to show that many pregnant women are deficient in omega-3 fatty acids, and when maternal intake is low, so is the mom’s DHA level which can affects mood. Fish oil capsules (I recommend Nordic Naturals prenatal fish oil products) can be trusted to be mercury-free, and vegetarians can use a product such as Omega Twin by Barleans. I recommend discontinuing use 2 weeks prior to the due date because of a small but possible increased risk of bleeding while supplementing. Though this is likely overly cautious, and most evidence suggests no risk, many herbalists have reported observing bruising in clients taking 2 g or more/day. If you do discontinue it, simply resume a few days after birth to help prevent postpartum depression.
  • Sam-E: A natural substance important for methylation, a process involved in making chemicals called neurotransmitters, which control mood, Sam-E has been well-studied and found to be safe in pregnancy. It should not be used in women with bipolar depression. A typical dose is 400 mg/day, but up to 800 mg (400 twice daily) may be needed for an optimal therapeutic effect. Rarely, it has been reported to cause mild gastrointestinal symptoms, sweating, dizziness, and anxiety.
  • Folate: Important for preventing neural tube defects in our babies, folate is also important for a healthy nervous system. Taking folate does not in itself seem to improve prenatal depression, but it does appear that women who have adequate folate intake respond better to treatment with antidepressant medications. It may also have protective effects against autism in our babies. I recommend 800 mcg – 2 mg of methylfolate daily, ideally starting 3 month prior to pregnancy, or at any point that you realize are pregnant.
  • St. John’s Wort: While the data is limited, and more studies are needed, especially given uncertainty over the safety of conventional antidepressant medications in pregnancy, studies on the effect of prenatal consumption of St. John’s wort on pregnancy in mice and rats were generally associated with normal gestation and offspring development. A limited number of human case reports indicated healthy pregnancies and infants when St. John’s wort was used prenatally. A standard adult dose is 300 mg 2-3 times/day, of a product standardized to 0.3% hypericin.
  • Probiotics: Increasing evidence suggests that disrupted flora can contribute to a disrupted mood, including depression and anxiety. Studies have shown that eating live active cultures such as found in yogurt can improve women’s moods! I extend this to fermented foods in general, such as sauerkraut, kimchee, and miso.  A good probiotic can also do the trick!

Check with your midwife or doctor before using if you are already on a medication or if you have any medical problems related to pregnancy).

10. Call on a Pregnancy Natural Medicine Expert
If after a couple of weeks of incorporating a combination of the above strategies you’re not noticing any improvements, this is a good time to consult with a medical provider who specializes specifically in the functional medicine, naturopathic, integrative, or mental health care of pregnant women. While self-care is the cornerstone of health, greater health challenges can be best addressed with a supportive, knowledgeable team.

Now it’s your turn to share! If you suffered from depression in a past pregnancy, what helped you to cope or heal? What do you wish someone had told you while you were pregnant that you can share as inspiration for other women?

Want to learn more about natural care for yourself during your pregnancy and beyond? You’ll love the down-to-earth nature of The Natural Pregnancy Book, and for after baby – Natural Health After Birth. They also make great gifts for other pregnant women in your life!

With love and compassion,

Aviva


References

Benard, A. et al. The risk of major cardiac malformations associated with paroxetine use during the first trimester of pregnancy: A systematic review and meta-analysis. British Journal of Clinical Pharmacology.doi: 10.1111/bcp.12849.

Freeman, MP. (2009). Complementary and alternative medicine for perinatal depression. Journal of Affective Disorders, 112: 1–10.

Hogg K, Price EM, et al. (2012). Prenatal and perinatal environmental influences on the human fetal and placental epigenome. Clin Pharmacol Ther, 92(6):716-26.

Misri, S and S Lusskin. (2013). Depression in pregnant women: Management. http://www.uptodate.com/contents/depression-in-pregnant-women-management?source=see_link

Muzik, M et al. (2012). Mindfulness yoga during pregnancy for psychiatrically at-risk women: Preliminary results from a pilot feasibility study. Complementary Therapies in Clinical Practice, 18:235-240.

Romm, A. (2014) Uncovering and Treating Depression during Pregnancy. Alternative and Complementary Therapies. In Press.