Healthy Vegan Pregnancy: Prenatal Care + Birth Preparation

Since announcing I was pregnant, I’ve received a lot of questions about how to have a healthy vegan pregnancy as well as how to have a healthy pregnancy in general. This is the third installment in what’s shaping up to be a four-post pregnancy series. Below you’ll find the nitty gritty details regarding my prenatal care as well as the materials and approach I used to prepare for birth. For information on prenatal meals + supplements, please see this post, and for information on my prenatal exercise routine + favorite vegan self-care products, please see this post.

Earlier this fall, I asked you all to share your most burning vegan pregnancy questions with me on Instagram, and I received an abundance of thought-provoking and important questions on the topic.

Most of the questions I received pertained to meals and supplements to support a healthy vegan pregnancy as well as my prenatal exercise routine (please see the first and second installments in this series of pregnancy posts if you’re interested in that information), but I also received questions about healthy, natural pregnancy in general. Specifically, many of you inquired about my prenatal care routine (e.g., whether I had an OB or midwife, thoughts on vaccinations during pregnancy, etc.) as well as how I prepared for childbirth.

This third post (in what’s shaping up to be a four-post series) will cover prenatal care as well as birth preparation.

Prenatal Care: From OB to Midwife

Long before getting pregnant, I knew that once the time came, I wanted to do everything in my power to have a natural birth with minimal interventions. Most of the women in my family, my mom included, had wonderful, positive experiences with natural childbirth, and so the seed for that intent was planted many, many years ago simply by route of familiarity.

Quick Note: I should preface this all by saying that this is a judgment-free zone. I have nothing at all against epidurals or women who pursue medically based pain management options. Rather, I wholeheartedly believe that each woman should feel empowered to choose—without judgment from others—the birth path that most optimally supports her and her baby.

When I found out I was pregnant last March, the first thing I did (after sharing the news with Dan) was call my OB to book my first prenatal appointment. It hadn’t occurred to me to consider another practice or approach for prenatal care.

I disclosed my hope to have a natural birth during my first prenatal visit and found that my OB was incredibly supportive. She was also supportive of my plan to hire a doula and noted that doulas are especially beneficial for women looking to have minimal interventions during childbirth. However, as my pregnancy progressed and I began rotating between other OBs at the practice, I felt less and less supported in my desire to have a natural birth with minimal interventions. Although my direct OB was phenomenally supportive, there was only a 33% chance she’d be the doctor on call when I went into labor.

And so, with the support of my doula, I made the decision to switch to a midwife practice affiliated with an entirely different hospital when I was 33 weeks pregnant. This was not an easy decision for me to make, and I’m lucky that this midwife practice was willing to take me on as a patient so far along in my pregnancy (many practices have a strict 30-week cutoff). However, because I’d been low-risk throughout my pregnancy, they were willing to make it happen.

This was the absolute best decision I could have made for my pregnancy.

My reason for disclosing the details here with you now isn’t to say that a midwife practice is the end-all, be-all for natural childbirth. No, no. Rather, my intent is simply to say that you should feel empowered to research and choose a practice that aligns with your wishes and desires. That may be an OB practice, or a midwife practice, or a practice that has both OBs and midwives on staff.

Ultimately, I chose a midwife practice that views childbirth as a natural event (especially for those with low-risk pregnancies) and their statistics support this philosophy. The OB practice I was with prior to the switch viewed childbirth as more of a medical event. This isn’t to say that one approach is right and the other is wrong, but rather that one philosophy resonated more strongly with my own perspective and beliefs.

Bottom line: Do your research and feel empowered to choose a path of prenatal care that most closely aligns with your values, beliefs, and desires for pregnancy and childbirth.

Prenatal Care Decisions: From Ultrasounds to Vaccinations

Just the sight of the V word probably has us all on the edge of our seats about to pounce. But let’s all keep our composure about us for a moment, alright? I’m not a person of extremes or black-and-white thinking (read: you won’t find a pro-vax or anti-vax campaign below). Rather, I’m a woman who believes that there are few things more powerful than an informed mind.

I also believe that it’s our responsibility as parents and as humans to be thoughtful, empowered, conscientious, and questioning consumers.

Why?

Because time and time again, standard protocols implemented in large systems—medical, nutrition, exercise, psychology, environmental, etc.—have eventually proven themselves wrong, sometimes even harmful. And yet the cancellation or removal of such protocols in favor of more evidence-based approaches takes time. Large systems are incredibly slow to change, even in the face of a substantial body of evidence that would otherwise support a swift shift of procedures to preserve the well-being of many.

Thus, as consumers, we’re faced with a decision:

We can blindly adhere to and abide by the protocols thrust upon us, or we can inform ourselves (via real research—as opposed to google-discovered op-ed pieces and forum debates), weigh the risks and benefits, and make informed, evidence-based decisions for ourselves and our little ones.

The latter path is by far the more difficult one to navigate but it’s a worthwhile and empowering adventure if you’re up for it.

So, ultrasounds and vaccinations during pregnancy…

You’re probably wondering why these are topics worth mentioning in this post. Prior to being pregnant myself, I would have been, too.

And trust me, I thought long and hard (for months) about whether or not I even wanted to touch this conversation. Although it would be far easier to avoid it, it didn’t sit well with me not to at least raise the topic for conversation after all that I’ve learned.

Ultrasounds During Pregnancy

Ultrasounds and pregnancy seem to go hand-in-hand. Prior to being pregnant, I never questioned the safety of ultrasounds. Rather, I assumed they were safe simply because of their widespread use.

However, as with any medical intervention, ultrasounds aren’t risk-free. And while it may be fun to take frequent peeks inside the womb, it’s important to weigh the risks and benefits of doing so and to make an informed decision. This is especially true given that studies haven’t demonstrated improved fetal outcomes with diagnostic ultrasounds.

Makes you wonder why they’re used at all, right?

To be fair, there are several things prenatal ultrasounds are great at.

Ultrasounds are the most accurate way to predict gestational age during the first trimester. They’re also helpful for determining the sex of the baby, confirming the presence of twins and multiples, and checking for ectopic pregnancies and placenta previa (i.e., low-lying placenta). Prenatal ultrasounds can also be used, along with other screening tools, to evaluate the risk of certain birth defects and/or genetic abnormalities, such as heart defects and trisomy 21, trisomy 18, and trisomy 13.

However, ultrasound safety hasn’t been proven and because of this, the American Congress of Obstetricians and Gynecologists takes the following stance on ultrasound use during pregnancy:

Currently, there is no evidence that ultrasound is harmful to a developing fetus. No links have been found between ultrasound and birth defects, childhood cancer, or developmental problems later in life. However, it is possible that effects could be identified in the future. For this reason, it is recommended that ultrasound exams be performed only for medical reasons by qualified health care professionals. Casual use of ultrasound during pregnancy should be avoided.

Did you know that many years ago women received prenatal x-rays during their pregnancies?

Although it sounds like an obviously terrible idea to the modern mind, x-rays were assumed safe for pregnant women for decades before evidence proved otherwise. Point being: Too often, diagnostic tools and medical interventions are considered innocent until proven guilty when perhaps it would be wiser to abide by the precautionary principle.

As history has taught us, current absence of proof of harm doesn’t imply safety.

While overt evidence of harm from prenatal ultrasounds has not been substantiated, ultrasounds do cause an increase in tissue temperature within the developing fetus. While a small increase in tissue temperature is believed to be safe, studies have found that ultrasounds may heat fetal tissues above the maximum safe temperature, especially when considering the increased strength of the continuous wave and spectral doppler ultrasounds so commonly used today (which are seven times stronger than those used just two decades ago). Ultrasounds also transmit high-frequency sound waves that babies tend to move away from in the womb (our little one did), perhaps because they’re feeling vibrations or heat or both.

For a far more in-depth look at the body of evidence, I suggest you start here, here, and here, and dive deeper into the research studies referenced within each of those snippet articles. And then do your own research, too. I find it’s valuable to play devil’s advocate when researching topics like this one and to specifically look for sound evidence to the contrary of my initial perspective.

This isn’t about cherry-picking data to fit a personal hypothesis, this is about gathering a wide and sound body of evidence to inform decision making.

And it’s important to remember that even the most well-executed research studies still have limitations. Stay curious and ask questions when presented with information. There’s always more to learn or another angle from which to view the stories we’re told and the information we’re given.

How Many and Which Ultrasounds Did I Receive?

I didn’t research any of this prior to my first prenatal ultrasound (at 8 weeks), so I had a dating ultrasound done then. However, in light of the information I found thereafter, I opted to forgo the nuchal translucency screening ultrasound. Instead, and with my OB’s support, I had the Noninvasive Prenatal Testing (NIPT) blood screening done, which is considered to be far more accurate at screening for various genetic abnormalities anyways.

I also had the 20-week ultrasound done but opted to forgo the optional 35-week ultrasound my midwife practice offered. Had I gone a full week past my due date, I would have followed my midwife practice’s recommendation to receive an ultrasound to check amniotic fluid levels.

Both my OB and midwife have a conservative approach when it comes to ultrasound use in pregnancy; however, it’s not uncommon to hear of practices using ultrasound technology at nearly every prenatal appointment. In fact, as of 2015, women with low-risk pregnancies were said to receive an average of 5.2 ultrasound scans per pregnancy (up 92% from 2004).

If I were to do it all over again knowing what I know now (and with similar, low-risk circumstances), I think I’d opt to have just one ultrasound completed at the 20-week mark instead of two (8 weeks and 20 weeks), but there’s no sense in fretting about past decisions. Plus, hearing our baby girl’s heartbeat at that 8-week ultrasound really put my mind at ease and made it all seem so much more real, so perhaps I wouldn’t change anything at all.

To Summarize

There are absolutely benefits to prenatal ultrasounds, but it’s important to avoid frivolous and non-medical use (e.g., “keepsake” ultrasounds), and it’s concerning that so many women, even those with low-risk pregnancies, are given potentially unnecessary ultrasounds. For more on this topic and to see what other like-minded moms-to-be did during their pregnancy, checkout this post from Mama Natural.

Vaccinations During Pregnancy

Cue the backfire effect. Only kidding… sort of?

In all seriousness though, I’m not here to tell you what to do or how to live your life. This is your body, your baby, and it’s imperative that you do what’s best for you given your unique circumstances. My point in broaching this highly controversial topic is simply to share what I’ve learned and to ignite thoughtful, open-minded questioning within you.

When it comes to our health and the health of our loved ones, ignorance is not bliss (nor is unquestioning adherence to the status quo).

Widely implemented medical practices and policies aren’t always evidence-based. Widespread application of interventions can begin with the best of intentions and yet fail to unravel despite mounting evidence of over-use or harm.

But we have a choice.

We can choose to faithfully follow suit without question or we can seek out a broad body of evidence, weigh the risks and benefits given our unique circumstances, and make an informed decision.

This isn’t about stirring the pot or about being on one side of a debate or the other. This also isn’t about invoking unnecessary arguments with trusted medical professionals.

This is about empowered living, and it’s about thoughtful, informed questioning of the status quo. Because if you don’t do it, no one’s going to do it for you.

Which Vaccines are Recommended for Pregnant Women + What Are Their Risks?

There are two vaccinations currently recommended for pregnant women: DTaP and flu vaccine.

DTaP. The DTaP is a combination vaccine that protects against Diptheria, Tetanus, and Pertussis. As recently as 2008, the CDC’s advisory committee on vaccines warned against administering the TDaP during pregnancy. Instead, pregnant women were told to wait until their babies were born to receive the TDaP to help create a protective cocooning effect. However, since 2013, without knowledge of long-term safety and with only a handful of methodically unsound, anecdotal studies to support the recommendation, the CDC began recommending that every pregnant woman in America receive the TDaP vaccine.

Why?

Babies can’t get vaccinated with the DTaP (the version used for infants and children under seven) until they’re two months old. However, if a mother receives the TDaP during pregnancy, she transfers protective antibodies to her unborn baby that help protect against Pertussis (i.e., Whooping Cough) during the first two months of life. This sounds like the perfect solution in theory, but the vaccine doesn’t come without its risks.

In 2001, the FDA issued a guideline stating that the safe amount of aluminum exposure for infants is just 4 to 5 micrograms per kilogram per day, which means the safe amount for a newborn weighing 8 pounds at birth is just 16 to 20 micrograms of aluminum per day. There are currently two brands of TDaP vaccine for adults and both contain high amounts of aluminum—between 250 and 330 micrograms or 15 to 20 times the FDA’s recommended daily limit of aluminum for an 8-pound newborn (let alone a much tinier baby in the womb).

Aluminum is a known neurotoxin (verified through human and animal studies) and acknowledged to be so by the FDA.

Specifically…

“Aluminum is known to be neurotoxic through increased lipid peroxidation, making cells more vulnerable to free radical attack. Lipid peroxidation refers to the oxidative breakdown of lipids. This is where free radicals (toxic chemicals) ‘steal’ electrons from the lipids in cell membranes, resulting in cell damage. All cell membranes are made of lipids, and avoiding this kind of damage is vital. All of these factors are more significant in infants during periods of rapid brain development.” (Thomas and Margulis, 2016, p. 19)

FLU VACCINE. Contracting the flu during pregnancy, especially during the third trimester, can make a woman very sick. And thus, pregnant women who catch it are at higher risk of severe illness and hospitalization than women who aren’t pregnant.

However, flu vaccines are some of the least efficacious vaccines on the market. For instance, the 2014-2015 flu vaccine was only 23 percent effective. Furthermore, a large study following almost 15,000 pregnant women over the course of five flu seasons showed that vaccinated women had the same risk for developing flu-like illnesses as unvaccinated pregnant women (Thomas and Margulis, 2016, p. 37).

Add to these meager statistics of effectiveness the fact that there are several risks associated with receiving the flu vaccine during pregnancy, including increased risk of eclampsia, inflammatory responses, and exposure to the vaccine preservative thimerosal (i.e., a mercury-based preservative that’s 49.6% ethylmercury by weight) unless a preservative-free version is administered, and it becomes a bit mind-boggling why this vaccine is being pushed on pregnant women.

See here for Dr. Kelly Brogan’s fresh, informed thoughts on flu vaccination during pregnancy.

Vaccinations During Pregnancy: My Approach

TDaP. Receiving the TDaP during pregnancy doesn’t come without its potential risks to a developing baby and yet there are also risks to not receiving it (e.g., your baby isn’t protected during those first two vulnerable months). The best any of us can do is weigh the risks/benefits and make an informed decision. Based on everything I read, I felt there were greater risks to my baby had I received the vaccine during pregnancy than not and thus I declined the vaccination. However, I received the TDaP myself a year before I got pregnant (too early to transfer antibodies to the baby in the womb but beneficial for cocooning purposes), and those who will be close to our little one during those first few months (e.g., Dan, grandparents, siblings, etc.) received the shot as well.

FLU VACCINE. I never receive the flu vaccine, so this one was an easy decline for me. Knock on wood, it’s been nearly 10 years since I’ve had the flu, and based on my experience, I’m confident that healthy lifestyle choices offer immune-boosting effects that far surpass those of the flu vaccine. Having said that, if you’re particularly susceptible to the flu and have found that the flu vaccine is indeed effective for you, then perhaps you’ll opt to receive it while pregnant.

Again, these are highly personal decisions and ones that each of us should feel empowered to make for ourselves without judgment from others (not even our doctors).

My intention here is simply to raise the topic for conversation and to encourage you to do your own research, weigh the risks/benefits, and make the choice that’s best for you and your family.

Please also keep in mind that as a school psychologist, I come to this conversation with a developmental perspective in mind (as opposed to a medical one) and am certainly biased toward that way of thinking. I’ve documented and read the results from thousands of assessments about everything that can and does go wrong in the minds of developing youth and am hypersensitive about these topics for this reason.

Safe Vaccination During Pregnancy, Infancy, and Childhood: An Invaluable Resource

For an evidenced-based, open-minded perspective on safe vaccination from pregnancy through your child’s teen years, there’s a book titled The Vaccine-Friendly Plan (written by Paul Thomas, MD and Jennifer Margulis, PhD) that’s praised and appreciated by people on ALL sides of the vaccine debate. It’s an evidenced-based approach to vaccinating and medicating safely based on a wide body of evidence. Again, it’s an invaluable read for ALL parents, no matter where your opinions on vaccinations currently reside, and I cannot recommend it enough. In addition to information on vaccines, the book offers extensive medical insights and tips for everything from natural pregnancy to those first few days with your newborn to tackling the teen years. If I were to recommend just one resource to you on the topic of pregnancy and evidence-based health protocols for little ones, it would be this book. 

Birthing Preparation + Planning

What’s a Doula?

Doula (pronounced ‘doo-la’) literally translates to “woman servant or caregiver,” but more generally it refers to a person who’s trained to offer emotional and physical support to a woman and her partner before, during, and after childbirth.

There are many well-documented benefits to having a doula present during childbirth, including reduced cesarean rate (by as much as 50%), reduced length of labor, reduced use of pitocin (i.e., the synthetic form of oxytocin used to induce labor), and reduced requests for an epidural (by as much as 60%).

The birth process is primarily driven by oxytocin (i.e., “the love hormone”). Fear and stress are two of the greatest threats to the natural, flowing release of oxytocin. Therefore, fear and stress can have direct and detrimental effects on the birthing process.

Studies have shown that if a woman in labor is stressed or frightened, her levels of adrenaline increase while her levels of oxytocin decrease. This can slow labor and even lead to heightened levels of pain being experienced by the mother. Why? Because high levels of adrenaline impede a woman’s production of the natural pain relievers (i.e., endorphins) released by the body during childbirth.

The doula’s primary role is to foster feelings of safety and support, thereby reducing feelings of stress and fear, which is why her/his presence during childbirth can have such positive effects on the experience as a whole.

Why I Hired a Doula

As I was researching natural childbirth in early pregnancy, I noticed that many women who had positive natural birth experiences also had a doula present at their baby’s birth.

After digging into the research on doulas and learning about the positive effects they have not only on a woman’s overall experience of childbirth but also on the number of interventions required during birth, I knew I wanted to hire one.

Knowing that I planned to have as natural a birth as possible, Dan fully supported me in this quest as well. Plus, doulas also provide support to the birth partner, and as a first-timer, he was happy to receive some extra guidance himself.

Why I Recommend Hiring a Doula

No matter where your childbirth hopes and wishes fall—whether you’re planning to go natural, keeping an open mind, or know without a doubt that you’ll be seeking an epidural—there are endless benefits to hiring a doula.

Here were a few stand-outs for me personally:

Prenatal meetings. Our doula provided two, two-hour prenatal meetings as part of her services. These meetings were invaluable in developing a birth plan and also for providing support throughout the last few months of pregnancy. Our doula also supported me during the transition from OB to midwife, and I’m not sure I would have made that leap without her guidance.

Open line of communication. From the time we hired her to the days after our baby’s birth, our doula availed herself via email, phone, and text. Any time we had a question (from birth preparation to breastfeeding), she was there to offer an answer and provide support.

Birthing support. Our doula waited on call for our birth during the five-week birthing window (i.e., 37 weeks to 42 weeks). When labor begins, the doula is typically the first person you’ll notify. That way, she can either come to your home to support you during the early stages of labor (and guide you on when it’s time to transition to the hospital) or meet you at the hospital straight away (if you’re progressing too quickly to wait).

Breastfeeding support. Our doula is also a certified lactation consultant and was able to provide breastfeeding tips, tricks, and guidance during both prenatal and postnatal phases.

Postnatal care. Our doula provided one, two-hour postnatal session as part of her services where she came to our home and helped us navigate the newborn experience.

Childbirth Classes + Programs

I looked into a fairly wide range of birth preparation programs.

My mom used lamaze back in the day, so that was the first one I investigated. However, it turns out that lamaze has changed quite a bit since my mom used it in the early 80’s, and it wasn’t a good fit for what I was looking for.

I also looked into some local “crash course” weekend birthing classes, but ultimately decided that I wanted a more comprehensive program and to learn bit-by-bit rather than all at once.

And so, by the time it came down to it, I had narrowed a wide pool of choices down to just three: Hypnobabies, HypnoBirthing, and The Bradley Method.

At first glance, I was drawn to the HypnoBirthing approach but ultimately decided I wanted a more extensive birthing program than what it offered. Since Hypnobabies offers a comprehensive, 6-week home study course, that’s the program I chose. There are in-person classes for Hypnobabies, but I wasn’t able to find any close enough to where we live and therefore decided to stick with the home study course.

The Hypnobabies program teaches real medical hypnosis techniques to encourage a more peaceful, relaxing, and comfortable pregnancy, and an easier, more comfortable childbirth experience. I’ll admit, at first, the idea of self-hypnosis during childbirth sounded a little extreme to me. However, after talking to our doula (she recently used the program during her own childbirth), it didn’t sound nearly as “out there” or intense as I had initially judged it to be. Rather, it sounded like a centered, peaceful approach to childbirth.

The nitty gritty…

Hypnobabies is a complete childbirth education course. The home study program lasts six weeks and entails about 2–3 hours of weekly class readings plus daily self-hypnosis practice (about 40 minutes of listening to a deep relaxation audio track each day). There’s also a 40-minute positive pregnancy affirmations track that you’re asked to listen to daily for all six weeks (the listening can be passive though—e.g., while you’re driving, making dinner, or even as you’re drifting off to sleep). The home study program comes with a six-week course workbook plus a companion workbook for your birth partner (if you have one—the program is also used successfully by single mothers).

Total honesty: The Hypnobabies program is highly effective but it’s a fairly major time commitment, and if you’re not willing to dedicate about 1–2 hours daily during the last six (or eight) weeks of your pregnancy, then it’s probably not the best program for you. As they say, it only works if you actually do it.

There was a two-week period when I was overbooked with last-minute prep work for my Chicago Ideas Week presentation, and I found it incredibly difficult to keep pace with the course. However, I took it all in stride and got caught up when I could.

Overall, I genuinely enjoyed the daily self-hypnosis practice and looked forward to that 40 minutes each day. It kept me balanced, centered, and relaxed, especially near the end of pregnancy when I started to become a bit anxious as we awaited her birth.

During birth itself, I relied on a few of the Hypnobabies audio tracks (especially as we made the 40-minute drive to the hospital), but overall, I found the most relief from turning inward, closing my eyes, relaxing my face and shoulders, maintaining a calm mind despite the increasing intensity of the contractions, and breathing deeply. I know this all sounds overly simple. But the mind truly is a powerful thing, and I noticed that I physically felt more pain at moments when my mind started to race or panic. Thankfully, our doula was able to observe and catch those moments by watching my facial expressions, and she’d provide cues and prompts to help re-center and calm me.

It’s hard to describe how those peak contractions feel. Pain isn’t really the right word. They’re more intense and powerful than anything I’ve ever felt. And they produce a total out-of-body experience. During transition, I remember doubting whether I could handle much more intensity. There reached a point when it was so great that my eyes filled with tears. But just as this happened, Dan came over and grasped my face in his hands, looked into my eyes, and told me how strong he thought I was. His eyes welled with tears, too, and something about that moment gave me the courage to keep going. Even though the intensity of the contractions was mine to endure alone, he was right there with me and I felt safe.

Although I didn’t rely on the full Hypnobabies protocol during birth, I’d be hard-pressed to say that all that preparation didn’t help me in some major way.

After Sloane was born, I overheard the midwife say to the OB on call, “She went completely med-free and was the calmest laborer I’ve seen in a long time.” A surprise to me because although I never yelled or screamed during labor, I moaned loudly, trembled and shook uncontrollably, collapsed into our doula’s arms at one point, and was hardly able to catch my breath at times. At the postpartum visit, our doula mentioned that I never once asked for pain medication or an epidural. She said that women will usually ask and sometimes beg for something during transition even when they ultimately end up making it through on their own. To be fair, I believe this was partially due to the Hypnobabies teachings but also the fact that the fear of a needle going in my back scared me far more than the pain of labor ever did.

This might sound silly, but I also envisioned all of the animals that give birth completely on their own everyday in the wild and felt so empowered and encouraged by that thought.

References

Thomas, P., Margulis, J. (2016). The Vaccine-Friendly Plan. New York, New York: Ballantine Books.