Hyperemesis Related Post Traumatic Stress Disorder (PTSD): Morning Sickness It's Not

It's an alien and a parasite. It makes me tired and weak. It's complicated my whole life. I resent it. I have no idea how to take care of it. I'm the anti-mother. ~The Waitress, 2007

Trusted Nurse Midwife Friend: "So, when are you going to get past this HG thing and have some more kids?"

Me: "Oh! I'm not. I can't. I can't get past it at all. As much as I love my child, and as much as I love being a mother, I can't begin to imagine having to go through that again, especially while caring for a toddler. All three of us would suffer. My husband may be OK. {giggle} Nope. I can't imagine. I couldn't put my family through that. I'm open to adoption though."

My Hyperemesis Gravidarum Story

A Pregnancy Fit For A Princess

I really do not mean to perseverate over my experience, but even after 3+ years, I cannot get beyond it enough to desire another pregnancy. I did not have a life-threatening pregnancy. My child's health was never at risk, but still... I would not mind revisiting the muscle aches, heartburn, constipation, shortness of breath, bladder urgency, fatigue, or even the 23 hours of unmedicated labor, that I experienced with my first pregnancy; but to have to suffer through that unrelenting nausea, vomiting, and lethargy, moment after moment, for weeks on end, is too much to imagine. Just after the birth of my daughter- you know when everyone immediately starts asking about baby #2- I joked about not being emotionally stable enough to endure a 2nd pregnancy. I always laughed, but now as a postpartum doula, I support many moms who have had birth trauma that leads to postpartum mood disorders. The more that I read about their complex and sometimes debilitating emotional state, and the more that I listen to their stories, the more I see myself in their struggle. Because I had an otherwise healthy pregnancy, a birth with minimal intervention, and a perfect child born at 40 weeks, I never considered that I was in the birth trauma crowd, or was at risk for pregnancy related depression or anxiety. I was wrong. I have slowly come to realize that I had post-traumatic stress disorder (PTSD) related to my hyperemesis gravidarum (HG). Yep! That's really a thing!

In the 1930s, Dr. Freud's popular psychodynamic theory was applied to women with HG, which resulted in physicians viewing mothers as mentally ill women with a subconscious rejection of the fetus, as if the she were literally trying to throw the baby up. It was further speculated that the mother's illness was related to broken relationships, broken homes, marital distress, depression, anxiety, abuse, resonating disorders, hysteria, sexual dysfunction, poor self-confidence, poor coping skills, and good ol' stress. The treatment of HG during ths time included isolating the mothers and leaving them to rot in their own vomit, without bowls or buckets, and without any assistance other than the regular presentation of more food, which every HG mom knows is the very last thing that is wanted. Later, intravenous fluids were used as a treatment, so while fewer women were dying as a result of HG, those who survived were still being mistreated. Although there have been additional medical advancements in the treatment of HG, these psychological factors continued to be cited as the source of nausea and vomiting through the 1990s, which means that even relatively young doctors, treating mothers today, learned this archaic information in medical school. Many are still telling mothers that they are just stressed or anxious. That's pretty scary. 

Fortunately today, there are more humane ways of treating HG... even though I was terribly isolated, because I could neither predict, nor recover from my nausea, vomiting, and simultaneous incontinence; and I did mostly, OK always, clean up my own vomit and urine, because it either happened while I was working alone, or overnight, when I did not want to wake my hardworking husband- especially after that time that he accused me of just wanting attention. I cringe to think about that even now, but he didn't know. He had never heard of HG (neither had I), and none of his six older sisters had ever experienced it, so there was no known source of empathy. The repeated need for IV fluids helped him to understand my need for help better, along the way. Zofran was the only way that I survived. Fortunately, my pregnancy occurred before the claims the drug causing birth defects. I really feel for those HG moms who had to suffer under that fearful shadow. 

“What was really significant to me was that women with extreme morning sickness who took Zofran reported fewer miscarriages and terminations and experienced higher live birth rates,” Fejzo said. “Taking this medication helped them get through their pregnancies and gave them their desired outcome, a live birth.”
Marlena Fejzo, PhD

Zofran Update

Today, it's clear that psychological factors do not cause HG, but they can definitely be the result of HG. An expectant mother who is violently ill throughought the day, to the point of ejecting blood and bile, having constant leakage from her eyes, nose, hoo-ha, and mouth (a condition called ptyalism), is going to be at risk for antepartum depression, postpartum depression and anxiety. Many women with HG are placed on bedrest, and many others should be. Those who are on bedrest are often too sick to journal, scrapbook, chat, or e-shop, like mothers who are resting for other conditions. Any mother who is too sick to work outside of the home or care for her children could very likely feel guilty; and her inability to contribute to her home, could create an additional strain on her marriage and finances. Insomnia and black-outs are common with HG. Emetophobia, or the fear of vomiting, creates even more anxiety and can lead to panic attacks. The fear of dying or actually wanting to die are very real thoughts for HG sufferers. Some medications even offer suicidal ideation as a side effect. Imagine that? 

I can remember being so sick on the day of my baby shower. It took me forever to pull myself together and get out of the house, but friends, including the hostesses had traveled 3 and 4 states away to honor me. I had to get it together. I was late for the shower, and they were irritated. I couldn't bring myself to complain about how I was feeling on that day. Who wants to be Debbie Downer at her own baby shower? So, I arrived when I could, and sadly, those relationships were strained as a result, leading to more isolation. One of the friends had incredibly survived HELLP and a subsequent premature delivery, and the other had never been pregnant. There was no easy way to explain this inescapable hell that happens to fewer than 5% of pregnant women, and typically results in a healthy birth. No way. 

I can also remember suffering in silence because my blood pressure and blood sugar were not at risk. My uterus was in a great space, my baby was growing well, and her heart rate was active. What did I have to complain about, when as an occupational therapist with NICU experience, I saw both mothers and neonates at far greater health risks? What I know now is that HG was tortuous and it robbed me of the joy and happiness of a major life event. It was miserable, it was traumatic, and it was a kind of loss. I was felt helpless, hopeless, withdrawn, and even ambivalent about the birth of my child, which of course brought on even more feelings of guilt, shame, and fear. Naturally, this experience puts HG moms at risk for depression, anxiety, and post traumatic stress disorders. 

Post traumatic stress disorder is caused by a single traumatic event, like a rape, assault, or natural disaster, but it can also be caused by prolonged exposure to an extremely stressful situation, like foster care, domestic violence, and hyperemesis gravidarum. Symptoms include disturbing thoughts, dreams, hallucinations, and feelings related to the event. They also include mental distress, physical distress, avoidance of related situations, and alterations in thought patterns, lasting for longer than a month after the event. Even though the nausea and vomiting are finally relieved at birth, when HG survivors have PTSD, they have an actual fear of getting pregnant, which may be extreme enough to avoid sex or rush into permanent birth control. How stressful is that on a marriage, especially one in which the mother was probably not ever excited about having sex during pregnancy? This avoidance could lead to yet another loss; this time, that of a larger family that was hoped for before HG reared its ugly head. A father, wanting to "try for a son", may become resentful of his HG survivor partner, who has absolutely no desire to become pregnant. Likewise, that mother may become resentful of her husband for pressuring her to do so. She may also become strangely resentful of her child or children who "caused" these horrible feelings of body and mind. 

Kate Middleton's Ongoing Condition Much Worse Than Morning Sickness 

Flashbacks, hallucinations, and panic attacks are signs of PTSD with HG survivors. Food anxiety can also appear during the postpartum period. Moms who have not been able to eat for 6-10 months, may experience a continued aversion to food, or overeating, similar to someone who was starving at some point. Both extremes are dangerous to the mother's health and her child's well being, especially if she is breastfeeding. The symptoms may show up at anytime after the birth, and may become especially exacerbated if a subsequent pregnancy does occur. Hyperemesis is typically present in and may be progressively more severe with each pregnancy. It does not usually abide by the "every pregnancy is different" rule. 

Physicians are doing a better job of identifying postpartum depression. There is a greater understanding and more empathy around this group of hormone related mental illnesses. Health care providers are even getting better at referring mothers who have had traumatic births to psychological care. Unfortunately, PTSD related to HG is less recognized, considered, diagnosed, taken seriously, or treated. PTSD can be terminal, but it is very treatable when symptoms are identified and help is sought. It's existence, severity, or impact should never be underestimated. Some survivors experience life long anxiety, especially around needles, hospitals, and medical procedures. Others are anxious and resentful around glowing mothers, as they continue to feel cheated by their dark pregnancy. These feelings intensify anytime HG is dumbed down to extreme morning sickness or a survivor's story is invalidated. 

For More Information, Visit Help HER

In order to minimize PTSD symptoms, at any phase, mothers should be able to rest and relax without guilt or additional stress. Any mother who has had a stressful pregnancy, or traumatic birth, should consider hiring a postpartum doula, in order to help with the transition of motherhood. She should also consider establishing a relationship with a psychologist or counselor who could screen for and treat any depression or PTSD. A strong, observant, and knowledgeable circle of support is vital.

So, while I am not into a position to move beyond my traumatic hyperemesis experience to the point of having another child, as a birthworker, I am eager to help mothers who have survived hyperememsis and want to live their best lives beyond that experience. If you need help, please reach out. You do not have to suffer in silence. You do not have to suffer alone.

What is your experience with Hyperemesis Gravidarum?

Living With Lupus... As A Mother

We may run, walk, stumble, drive, or fly, but let us never lose sight of the reason for the journey, or miss a chance to see a rainbow on the way. -- Gloria Gaither

Pregnancy and motherhood come with their own set of challenges. From impossible fatigue to seemingly endless aches and pains, new mothers experience a wide array of symptoms that can make the whole mom thing less than fun. However, when those common symptoms are exacerbated by the pain, inflammation, irritation, respiratory distress, and suceptible immunity of lupus, there are many other factors to consider, for mothers, her child, and her circle of support.

What Is Lupus? 

Lupus is a chronic autoimmune disorder, wherein damaged cells of the immune system attack healthy cells of multiple systems, leading to inflammation, joint pain, and skin rashes, in addition to kidney, heart, lung, nerve, and liver damage, in severe cases. Digestive issues and anemia are also areas of concern. All over, and usually, symmetrical joint pain is often the first sign. There may also be a common "butterfly" rash across the face, along with other skin irritations, sensitivities to the sun, and mouth ulcers. In fact, the entire integumentary system may be affected in the form of scaly skin, brittle nails, and patchy hair loss. Another symptom is unrelenting and debilitating fatigue, often with a low-grade fever. Lupus shares many symptoms with rheumatoid arthritis, fibromyalgia, Sjögren's syndrome, and other autoimmune conditions. A battery of lab tests and history help to diagnose lupus. Women are 10 times more likely to get lupus than men, and women who are African-American, between the ages of 20-40, and related to someone with lupus, are more more likely to get the he incurable condition, than other groups. The symptoms of lupus come and go, present themselves one at a time, altogether, or in any combination, and can be treated by addressing its multiple symptoms with corticosteroid pills or cremes, NSAIDs, and antimalarial medications. People living with lupus are at an increased risk of developing heart disease and having a stroke. 

Lupus- What Is It? 

Lupus and Fertility 

Lupus alone does not create issues with fertility. During the preconception period, a woman with lupus should meet with a rheumatologist, perinatologist, and a pediatric cardiologist, in order to discuss risks and options for both mother and child, including finding a hospital that specializes in specialized infant care. Hopeful mothers should adopt and maintain a healthy lifestyle in order to minimize lupus-related symptoms. Women who conceive while symptoms are in remission are less likely to have complications during pregnancy. While fewer than 50% of lupus pregnancies have complications, all pregnant women with lupus are considered high risk. Planning pregnancies while living with lupus is important.

Lupus and Self-Care 

Lupus and Pregnancy

The pregnancy complications associated with lupus include an increased risk of miscarriage, still birth, prematurity, preeclampsia, and HELLP syndrome.  In order to monitor and decrease these risks, more frequent doctors' visits are necessary and eventual bedrest is likely. All pregnancies are different. Some will require treatment early on to adjust medication levels, while others require frequent monitoring after the first trimester, in order to check for blood clots, blood pressure, fetal growth, and offer reassurance, often via ultrasound. The physiological demands of pregnancy can often place extra stress on the mother's heart, liver, and kidneys. Expectant mothers and their partners should be extra vigilant about lupus flares. Although they are rare during pregnancy, they often appear as exaggerated signs of pregnancy, including fatigue, joint swelling, fluid accumulation, skin changes, and hair changes. Just as in a normal pregnancy, nutrition, weight management, and rest are essential for an optimal birth outcome.

Neonatal Lupus

Most babies born to women with lupus are born healthy, when full-term. Those that are born prematurely, are at risk for the same heart, lung, digestion, and growth complications as other preemies. In very rare cases, the newborn can have neonatal lupus, which may mimic mom's symptoms of skin rashes, anemia, or liver problems. These symptoms usually go away after a few months and do not cause permanent damage. If a newborn presents with a heart condition related to neonatal lupus, the prognosis is more concerning. 

Autoimmune Disorders and Breastfeeding 

Breastfeeding and Postpartum 

Lupus itself does not prevent breastfeeding and since lupus is not contagious, it cannot be passed to the baby through breast milk. However, new mothers may still experience breastfeeding challenges. For example, if the mother was very sick or medicated at the end of her pregnancy, she may have difficulty producing milk right away, especially if the birth was premature, as nearly 50% of lupus-pregnancies are. In this case, be patient, seek assistance from a lactation professional (early and often), continue to express milk, be available for kangaroo care, and ask for donor milk. A pre-term infant may have developmental challenges that make breastfeeding complex, but also very important. Along with the numerous well-known benefits of breastmilk, the milk of a mother with lupus, has properties that may help decrease the risk of the infant developing lupus later in life. In addition to utilizing the services of a lactation consultant, a new mother with lupus may 
consider hiring a postpartum doula to help manage physical recovery, baby care, and home care. As mentioned earlier, symptoms may be surpressed during the pregnancy, but the stress of motherhood could contribute to a flare up after the birth, especially if the child is fragile, or when the mother returns to work. 

15 Reasons To Call A Lactation Consultant 

Nutrition 

Nutritional choices neither cause, nor cure lupus, however, healthy food choices are an integral part of the overall treatment plan, especially during pregnancy. As a general rule, the diet should be well-balanced, anti-inflammatory  consisting of vegetables, fruits, oily fish, and limited amounts of whole grains, lean poultry, and beef. Avoiding the major inflammation causing foods, is as equally important. The goal of nutrition is to reduce inflammation and other symptoms, maintain strong joints and muscles, minimize side effects of medications, maintain a healthy weight, and reduce the risk of heart disease. 

Foods That CAUSE Inflammation 

Mental Health and Self-Care

Like many chronic illnesses, depression and anxiety are a risk for those living with lupus. The unpredictable pain, in combination with the emotional stress of coping with daily obligations, can often be too much to bear without intervention or support. It is vital that a self-care plan includes stress & pain management, regular exercise, a balanced diet, social support, rest, and regular mental health assessments. 

If you know a mother who is living with lupus, reach out to her and offer a bit more support than you have been, regardless of the age of her children. She's probably more tired than the average mother. If you know a woman with lupus who is trying to conceive, check in with her to make sure that she's making healthy choices the majority of the time. If you are a mother living with lupus, know that we think the world of you, we are cheering for you, and we support you and your amazing self. Take care. 

The Myriad of Emotions Associated with Mother's Day!

Each year, I reflect with gratitude on Mother's Day 2012, when I had recently left my corporate health care job in order to focus on my own women's wellness business, full time. It was on that day, while celebrating my own mother with my nieces, that immense nausea and fatigue led me to the drug store, where I purchased a digital pregnancy test, and moments later, learned that I was indeed getting ready to be a mother myself. I experienced a tremendous range of emotions right then. Today, as I celebrate my fourth Mother's Day (tee-hee), I am still grateful. I am blessed to be able to spend another Mother's Day with my own mother and to be around aunts and cousins who are also mothers.

At the same time, I am filled with a deep sadness for those longing for and missing their mothers because of loss, including my parents, my husband, my siblings, several of my closest cousins, and too many friends. I send sweet thoughts to those whose mothers are ailing with physical or mental disease, as well as to those who cannot travel to see their mothers because of distance, expense, inflexibility, brokenness, or conflict. 

As a birthworker, I spend Mother's Day sending love and light to those whom have lost children. I send miracles and blessings to the mothers of unborn children, still born children, and those struggling with infertility. I am thinking of those mothers who have had to bury an infant, child, adolescent, or an adult child. I am sending patience and forgiveness to mothers whom have lost their children to incarceration, addiction, or other destructive decisions. My heart goes out to the mothers whom have had forced or elective abortions. May the guilt, fear, pain, shame, grief, or isolation of these losses be transformed into peace, healing, power, inspiration, and possibility. 

                                                         An Open Letter To Mothers

I have so much compassion for the moms who have to work too many hours and too many jobs to see their children, just so that their basic needs are met. I feel for moms who have to drop their infants off with strangers at a daycare at 6 weeks because they can't afford to be off work another day. I feel for single mothers, mothers without support, those with strained interpersonal relationships, mental illnesses, or physical limitations- moms who just need a 
few more resources, and a lot more hugs. 

I stand in awe of the mothers who are mothering other mothers' children. To the foster and adoptive mothers, grandmothers, aunties, big sisters, family friends, teachers, mentors, and next door neighbors who have stepped in to mother, she it was impossible, unreasonable, or unsafe for the birth mother to be a mom, I salute you. We support the often misunderstood and lonely experience of the mother of children with special needs. 

15 Inspirational Mother's Day Quotes 

Mother's Day is an emotionally complex day. My hope is that wherever and whenever moms need to be celebrated, elevated, appreciated, supported, remembered, prayered for, or fought for, they are, each of them, today and every day. 

Happy Mother's Day! 

Self-Care For The Service Provider

“Caring for myself is not self-indulgence, it is self-preservation, and that is an act of political warfare.” ~Audre Lorde

This one is for me. I have spent nearly 20 years in the health and wellness industry. I have multiple degrees, specializations, and certifications. I help people. I love what I do. From preterm infants to children with special needs to adults with work-related injuries to pregnant women to cancer survivors and those on hospice, I help people. I love what I do, in all of the ways that I do it. 

Sometimes, however, I am drained. I spend my days and nights trying to find ways to educate and empower others to live their best lives and achieve optimal health via a wide range of modalities. For a while, I was a great example of the kind of living that I was proposing. I ate well, I worked out regularly and vigorously, I meditated, I traveled, and I practiced self-care as a way of life, not just some birthday treat.

Nosara, Costa Rica

However, when I became pregnant, everything shifted. Not just my internal organs and my SI joint, but my priorities and my perspective. From the moment that I found out that I was pregnant, I made every life choice based on my daughter coming into and thriving in this world. The only issue was that this singularly pointed focus was leading to the demise of my well-balanced life. I was a pregnancy nutrition coach and prenatal massage therapist, who only ate toast and jell-o throughout pregnancy, because of hyperemesis, and received exactly 2 prenatal massages in 40 weeks, while recommending that expectant moms should get a massage as often as they see their provider (because that's how often changes are occurring within the body). I did teach and practice yoga throughout my pregnacy, which was my saving grace. Other than that, I was the barefoot and pregnant cobbler.

Survival Tips For Women Who Do Too Much

The pregnancy was the beginning of the end for my active self-care regimen. In my, I moved 
3 states away. I moved away from my friends, family, yoga studio, nail tech, spa, hiking trail, make-up counter, running crew, martini & tapas spot, juice bar, stylist, shoe shop, and dress boutique. I had my husband, but he works very long hours, and wasn't that great of at scouting out locations that I would definitely love. I birthed my daughter in January, went into hibernation, and essentially, did not reemerge until late April. I actually loved being my daughter's everything during that time, despite not knowing how to get to Target, or where to go for the best mani-pedi. I did, however, begin teaching at a great yoga studio, which is where my post-pregancy life began to open up. I was venturing out in the town and on the trails. I was talking to adults. My husband gifted me with new running shoes, for my "new" feet, and I began racing again. I returned to occupational therapy part-time, and although I was exhausted, I was on a roll... until we lost our childcare providerS. Then, it was back to baby and me- for more than a year. That was unexpected. 

Tennessee State University's 5K
Nashville, TN

My focus returned to her 19/7. My amazing husband took over in the evenings... still does. During this time, we spent days eating the same snacks and wearing the same jammies. We promised play dates with friends, but they rarely happened. We took walks daily, but they weren't competing with the snacks. I was slowly finding out about juice bars and natural hair stylists, but I never made the provisions to go. My SnapBack had expanded and my energy and motivation were at an all time low.

Why I Am Not A Bad B!

Because of my love affair with breastfeeding, during this time, I became a lactation counselor. Because I was quite unsupported after giving birth, I augmented my experience 
as a birth doula, with training to become a postpartum doula. I also became a licensed Oh Baby! Fitness provider. Still, everything that I was doing was for other people. In 2006, I launched an Atlanta-based women's wellness company, and we closed its doors shortly after my daughter was born. Ironically, our tag line was "Perfecting The Art of Selfless Indulgence", because I know that women have a lot of guilt around taking care of themselves. In 2015, I launched another company, this time focused completely on perinatal health and wellness for new and expectant moms, so that I could be the kind of provider that I did not have during that phase of my life. 

How We Got Here

Delving more deeply into the birth world is how I discovered the amazing work of 
Panquetzani Ticitl,  a holistic womb counselor, complete wellness coach, traditional birth attendant, and foundress of Indigemama. This weekend, the universe saw fit for me to attend her Matriz y Concha workshop for womb health and healing, hosted by the equally amazing Claudia Booker. Just a few of the varied benefits of of optimal womb health include treatment for PCOS, endometriosis, blocked fallopian tubes, blood clots during menstruation, ovarian cysts, hormonal imbalances, uterine fibroids, unexplained infertility, poor egg health, ovarian failure, stress from infertility, lack of menstruation, excessive menstruation, constipation, pain during ovulation, tilted uterus, scar tissue, gas, and painful sex. This work greatly complements the work that I do as a pelvic floor therapist. 

Panquetzani! 

Initially, I desired to attend the workshop so that I could help my clients in deeper and more meaningful ways. I will be able to do that. What I did not expect, was the nourishing and nurturing way in which I will be able to help myself and my own womb, which is the center of life, love, abundance, sustenance, and all creativity. During this workshop, I realized that while I genuinely love helping others, I often focus on finding ways to do that in order to ignore all of the ways that I too, need help. I also made peace with my own womb for causing so much pain over the years, thanking her appropriately for helping to create and sustain the life of my child, and decided that we could remain united, despite my not wanting to have more children. I was elated to discover how, and more importantly, why to attend to my own self-care needs on a regular basis, and in my own home. I am replenished. I am invigorated. I am alive! I cannot wait to implement the womb nutrition, womb massage, womb fitness, and vaginal steam (YES!), into my own practice and my own life! 

Do you have questions about womb wellness? I can help! 

World Doula Week Is A Thing! But Why?

“Birth is not only about making babies.  Birth is about making mothers – strong, competent, capable mothers who trust themselves and know their inner strength.”       ~ Barbara Katz Rothmans

The word "doula" comes from the ancient Greek meaning "a woman who serves" and is now used to refer to a trained and experienced professional who provides continuous physical, emotional and informational support to the mother before, during and just after birth; or who provides emotional and practical support during the postpartum period.

Studies have shown that when doulas attend birth, labors are shorter with fewer complications, babies are healthier and they breastfeed more easily. Read more from Dona and CAPPA, the two agencies where I completed my birth and postpartum doula trainings, respectively. 

World Doula Week is celebrated, every year from March 22-28. The purpose of World Doula Week ("WDW") is to empower doulas all over the world to improve the physiological, social, emotional, and psychological health of women, newborns and families in birth and in the postpartum period. The World Doula Week events take place all over the world during the same week, stating the benefits of the presence of doulas in birth and in the postpartum period:

* Reduces the incidence of c-sections      

* May shorten the length of labor      

* Reduces epidural and analgesic requests      

* Increases breastfeeding initiation and continuation     

* Increases mother’s satisfaction of birth experience      

* Can reduce the incidence of postpartum mood disorders     

* Increases new parents’ confidence in the care of their newborn

Celebrate with me! I Love What I Doula!

Breathtaking Birth Photos That Celebrate Doulas

Why I Hired A Doula

Day 1: Doula Selfie

The Price And Value Of Doulas

Day 2: Favorite Quote
Pregnancy, childbirth, breastfeeding, child rearing... this applies to all.

What Is A Postpartum Doula? 

Day 3: Favorite Tool
My Heart and My Hands
Since I am also a nutritionist and massage therapist, I find that I do my best work with my hands, using my heart as a guide.

The First 72 Hours Postpartum

Day 4: Client Testimonial
Humbled

Mothering The Mother

Day 5: Your Doula Bag
I try to keep the amount of items that I take into the home to a minimum. I do use teas, coconut and essential oils for mom. In an effort to Go Green, I use my iPad quite a bit to show videos, share resources, and entertain older children.

What Is The Difference Between A Doula And A Midwife

Day 6: Doula Mentor
I work within a small community of birth and postpartum doulas, but I am influenced by birth workers from all over the world. 

Postpartum Support... In Japan

Day 7: Where You Work
I live and work in Memphis, the city where my husband and my child were born.
We are at the top of every bad list and at the bottom of every good list...
so there is lots of room for improvement and lots of work for doulas to do!

Video: Alarming Health Disparities In The Midsouth

Yo! Microphone Check One, Two! What Is This?! Phife Dawg, Diabetes, and Maternal Wellness!

So nowadays I go and see wifey just to cure me from stress

Lay my head on her breast, Sugar Dumpling knows best

Explaining all my problems to her, gettin' things off my chest
A lil hug up, squeeze up and no more am I vexed
Aye yo Sun, without my peeps I'd be truly assed out
Making sure I have my medications so I wouldn't pass out 
~Stressed Out, Phife Dawg, A Tribe Called Quest 

Now Here's a Funky Introduction of How Nice I Am... 

Before I was a mother, childbirth educator, yogini, nutritionist, or lactivist, I was hip-hop. Although I grew up in suburban Ohio, and attended a Catholic school, I was deeply connected to hip-hop (even if just in my heart and mind). I was in a breakdancing group, where my classical ballet, tap, and gymnastics lessons helped me to stand out; I had a rap alias: Def Lady J; I memorized and recited other artists' rhymes in my sparer time- many of which I still know; I spent every dime of my allowance in the brand new, but very tiny, rap section of my local record store; between 1987 and 1992, my mother made sure that I didn't miss a rap concert within the tri-state area... and I sold dubbed copies of songs that weren't available in stores- I'm still not revealing my sources, but I don't  get down like that anymore. Today, I'm always blasting Backspin and marauding for ears at classic Hip-Hop Karaoke events. I love and live this stuff.

Check The Rhyme

Hip-Hop Karaoke

Heartbeats & Hip-Hop

My Aura's Positive, I Don't Promote No Junk

Why does any of this matter, and what does any of it have to do with maternal health and wellness? Last week, beloved lyricist, and member of the quintessential rap group, A Tribe Called Quest, Malik "Phife Dawg" Taylor, passed away at the age of 45, after a 25+ year battle with juvenile diabetes. Even though his struggles with the incurable disease have been largely public and referenced in his own rhimes, interviews, and the terribly difficult-to-digest documentary Beats, Rhymes, and Life, the hip-hop community was still buggin' out that the 5 Foot Assassin had met his final day. In the middle of the night, as I cruised the Internet for information to share with my new and expectant moms, I saw the first posts and tweets about the Funky Diabetic. I initially prayed that it was one of those sick Internet jokes. It wasn't. Phife is gone. It is difficult to accept that our contemporaries, those whom we've watched grow up, are now too soon passing away from health related conditions: J-Dilla,  Guru, Nate Dogg, Heavy D, DJ EZ Rock, Sean Price, and (maybe) Chris Lighty. Now Phife Dawg adds to that number and brings subject of diabetes to the forefront. It's time to expand the subject matter that touches everybody, so that it reaches everybody. 

Atlanta's Traffic Reporter Mark Arum Is On Point With This Phife Dawg Tribute

Styles Upon Styles Upon Styles... 
Three Types of Diabetes

Diabetes or diabetes mellitus (DM), is a group of metabolic diseases in which a person has high blood glucose (blood sugar), either because insulin production is inadequate, or because the body's cells do not respond properly to insulin, or both. Individuals with high blood sugar will typically experience polyuria (frequent urination), they will become increasingly thirsty (polydipsia) and hungry (polyphagia). There are three types of diabetes: Gestational, Adult Onset. and Juvenile- the latter was Phife's kryptonite.

Gestational diabetes begins when a pregnant woman's hormones interfere with her ability to make and use all the insulin she needs for growing her baby. Gestational diabetes affects a mother late in pregnancy who is often asymptomatic; therefore pregnant women are routinely tested for this condition during their second trimester. The condition shows up in women not previously diagnosed with diabetes. It typically resolves after the birth of the baby, but the mother is now at greater risk for developing type 2 diabetes, while the child is at a greater risk of being a "big baby", becoming obese, and also developing type 2 diabetes later in life. Having a big baby (8 lbs. 3 oz., or heavier) can lead to additional discomforts toward the end of the pregnancy, and long term pelvic floor damage beyond pregnancy. More importantly, women with gestational diabetes are more likely to develop preeclampsia, be on bedrest, go into preterm labor, request an epidural, be induced, receive an episiotomy (or natural tear), or have a planned or emergency C-section. Incidentally, all of these complications can make breastfeeding more challenging. However, breastfeeding decreases the risk of the infant developing both type 1 and type 2 diabetes, so ask for help from a lactation consultant early and often. 

{Preeclampsia is a pregnancy complication characterized by high blood pressure and signs of damage to another organ system, often the kidneys. Preeclampsia usually begins after 20 weeks of pregnancy in a woman whose blood pressure had been normal. Even a slight rise in blood pressure may be a sign of preeclampsia. Left untreated, preeclampsia can lead to serious — even fatal — complications for both you and your baby. If you have preeclampsia, the only cure is delivery of your baby}

During the process of vaginal birth, this big baby is at a greater risk for nerve damage, shoulder injury, or even brain injury. If a woman’s diabetes was not well controlled during pregnancy, her baby can very quickly develop low blood sugar after birth. The baby’s blood sugar must be watched for several hours after delivery. Often gestational diabetes can be controlled through eating healthy foods and regular exercise. Sometimes a woman with gestational diabetes must also take insulin during pregnancy. Even if the diabetes does go away after the baby is born, half of all women who had gestational diabetes develop type 2 diabetes later. It's important for a woman who has had gestational diabetes to continue to exercise and eat a healthy diet after pregnancy to prevent or delay getting type 2 diabetes. She should also remind her doctor to check her blood sugar every 1 to 3 years.

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Diabetes Type 2

Adult onset, or Type 2 Diabetes, is the most common type. The name can be misleading as more American children are being diagnosed with type 2 diabetes because of our high sugar and high fat diets, along with our increasingly sedentary lifestyles. In type 2 diabetes, the body produces more blood sugar than it is able to use efficiently, without overtaxing other organs. There are many factors that can place an individual at risk for type 2 diabetes, including a genetic predisposition, extra weight, excess glucose from the liver, poor communication between cells, and metabolic syndrome.

{Metabolic Syndrome describes a group of conditions including insulin resistance, high blood glucose, extra fat around the waist, high blood pressure, high cholesterol, high blood pressure, and high triglycerides, that increases the risk for diabetes, heart disease, and stroke}

Women who have polycystic ovary syndrome (PCOS), have given birth to a baby weighing over 9 pounds, or as mentioned previously, gestational diabetes, are also at an increased risk for developing type 2 diabetes. Over time, mismanaged blood sugar can cause complications with the heart, arteries, veins, kidneys, eyes, nerves, digestion, libido, wound healing, and of course pregnancy. Having type 2 diabetes at the onset of pregnancy can cause birth defects early in the formation of the baby, unlike gestational diabetes, which does not begin to complicate the pregnancy until after the baby has already been formed. Type 2 diabetes is also a risk factor for preeclampsia and its associated issues. Embracing a general healthy lifestyle can decrease in one's risk of developing type 2 diabetes. Enjoying a well-balanced, nutrient dense, low sugar, low-fat diet; exercising regularly; managing weight and  stress; getting adequate rest; and not smoking; are ways to minimize the risk of developing type 2 diabetes, as well as reversing it if a diagnosis has already been given. 

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Diabetes Type 1

Phife was diagnosed with the less common, but more complicated Type 1 Diabetes, a few months before his 20th birthday. His grandmother, a nurse, recognized one of the signs (frequent urination) and tested him after a show. In type 1 diabetes, the body does not produce insulin, the hormone needed to get glucose from the bloodstream into the cells. Type 1 diabetes is incurable and is not preventable. There are known factors that increase the risk of developing type 1 diabetes, including a family history and genetic susceptibility. There are additional risk factors, including Viral exposure: Exposure to Epstein-Barr virus, coxsackie virus, rubella or cytomegalovirus may trigger the autoimmune destruction of the islet cells, or the virus may directly infect the islet cells. Low vitamin D levels: Research suggests that vitamin D may protect against type 1 diabetes. However, early intake of cow's milk — a common source of vitamin D — has been linked to an increased risk of type 1 diabetes. Other dietary factors: Drinking infant formula and water that contains nitrates may increase the risk of type 1 diabetes. The timing of the introduction of cereal into a baby's diet also may affect a child's risk of type 1 diabetes. Between the ages 5 and 7 months appears to be the optimal time for introducing foods. The current recommendation is to skip rice cereal altogether, and certainly, DO NOT put it in a bottle with breastmilk or formula, no matter what Nana says! Proper education on maternal and infant nutrition, could help to decrease the numbers of those affected by diabetes, and save billions of dollars in health care costs.

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Lifestyle Management

It is often a challenge to talk about health conditions that can be managed by lifestyle changes, without making the individual or parent feel guilty or defensive. Diabetes- all types- is one of those conditions. Type 1 diabetes can affect nearly every major system in your child's body, including the heart, blood vessels, nerves, intestines, eyes, bones, immunity, and kidneys. Long-term complications of type 1 diabetes develop gradually, so it is important to stay on alert of even subtle changes in health. Eventually, if blood sugar levels aren't well-controlled, diabetes complications may be disabling or even life-threatening, requiring dialysis or kidney transplant. Phife had both. The good news is that keeping the blood sugar level close to normal most of the time can dramatically reduce the risk of these complications. Maintaining a healthy diet, that includes plenty of fruits, vegetables, and whole grains, while limiting processed, high fat, high caloric, and high sugar foods, is a great first step. Eating on schedule, exercising regularly, checking insulin, taking medication, and resting well, are other important ways to manage type 1 diabetes.

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Other Considerations

People with diabetes have an increased risk of depression and anxiety, which may be why many diabetes specialists regularly include a social worker or psychologist as part of their diabetes care team. Women with any type of diabetes during pregnancy are at an increased risk for developing postpartum depression, and should be assessed and monitored accordingly.

When it comes to diabetes and infertility, there IS a connection for both men and women. In men, DM is a triple threat to fertility. It causes erectile dysfunction, lowers testosterone and libido, and reduces ejaculate volume. For women, diabetes alone does not keep them from getting pregnant, but it often times keeps them from staying pregnant. In many cases, “a woman with higher than normal glucose levels does get pregnant month after month. Unfortunately her diabetes status prevents that embryo from implanting in the uterus, causing a miscarriage before she ever realizes she is pregnant.” In this case, the diabetes isn’t preventing conception, but is preventing an ongoing pregnancy. High glucose levels are reported to increase a woman’s chances of miscarriage by 30-60%. If a couple is having fertility issues, insulin levels may be the culprit.

Prediabetes is a “pre-diagnosis” of diabetes— a warning sign. Take heed! It’s when your blood glucose level is higher than normal, but it’s not high enough to be considered diabetes. Prediabetes is an indication that you could develop type 2 diabetes if you don’t make serious lifestyle changes. It is possible to prevent prediabetes from developing into type 2 diabetes. Consistently eating healthy food, losing weight, and being physically active can help you bring your blood glucose level back into the normal range.

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Addressing prevention or lifestyle management in the time of a loved-one's passing, or failing health, can seem calloused or accusatory, but I feel confident that Phife himself would want his illness and subsequent transition to be used to benefit others. He spoke often about not taking his health seriously but wanting to help others. He had been very candid about having challenges managing his diet, exercise, and rest needs. Maintaining a healthy lifestyle may not be easy or convenient, initially, but it does not have to be dull or restrictive. In fact, it is nothing more than the lifestyle from which we could all benefit every day. The routine can become second nature, especially within a supportive environment. It is essential for all of us to be educated about how and why we need to make healthy choices and encourage our favorite mothers, children, and hip-hop icons to do the same. For Phife, let's all eat and move like our lives depend on it.

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