Sleep. We all need it and most of us would benefit from better sleep or more sleep. During pregnancy, getting good sleep or enough sleep can be challenging.  

Pregnancy can create new issues with sleeping. Trying to get comfortable, having to get up to go to the bathroom, having vivid dreams, and not being able to fall asleep again if waking up are common issues that can interfere with sleep during pregnancy.

Getting comfortable can be a challenge, especially if you are used to sleeping on your back. Pillows can be your best friend in this situation. Putting a pillow under a hip just enough to tilt you off your back can help in early pregnancy.  As your baby grows, having a pillow tucked behind your back, one between your knees, and one to support your belly may help you with being comfortable. I am a huge fan of the pregnancy pillows that surround you, almost like a nest. As pregnancy progresses, you might need more pillows for more support, or you might want your partner to tuck you into bed, helping get the pillows just right to let you sleep in comfort and bliss.

Vivid dreams can be something else that interferes with sleep. These dreams can be weird, intense or scary.  It seems like the mind goes into overdrive as you sleep, and you just don't feel as rested as you would with more normal dreams. Catnip tea, or Valerian tea are options to help you quiet your mind and let you have more restful dreams. Have a cup shortly before you go to bed.

If you are waking up often, or having a hard time getting to sleep in the first place, it might be time to add a snack to your bedtime routine. Sometimes your blood sugar can drop low enough that your body just isn't happy and it will wake you up or keep you awake. I recommend a protein rich snack such as nuts, cheese, or jerky before bed. If you fall asleep easily enough but can't get to sleep after waking up to go to the bathroom in the middle of the night, try adding in a small protein rich snack while you are up.

In the last trimester, many mothers can sleep but it is often interrupted by having to go to the bathroom multiple times in the night. Baby might be low enough to use your bladder as a pillow which means there's just less capacity in there. My suggestion for this situation is to set a cut off time for hydrating and focus on getting all your hydration in before that cut off time. Usually 2 hours before bed is plenty of time. Just make sure to start hydrating again as soon as you wake up for the day.

Hopefully, these ideas will having you sleeping through your pregnancy like a baby!  

How much weight will I gain in pregnancy?  How much weight should I gain in pregnancy?  What can I do to keep weight gain down during pregnancy?  What if I gain too much weight while I'm pregnant?  Should I lose weight while I'm pregnant because I started pregnancy overweight? These are all questions I have been asked in my midwifery practice.

We know some of the weight gain that comes with pregnancy will go away with birth. Expanding blood volume is 3-4 pounds, amniotic fluid is about 2 pounds, the placenta is about 1 1/2 pounds, 2 lbs as breast tissues preps for breastfeeding, and your baby may weigh 7-8 pounds.  So, with birth you will drop around 12 pounds or more as soon as birth happens, and lose a few more pounds as your blood volume returns to normal levels. 

ACOG has guidelines on weight gain that are tied to what BMI was before pregnancy. The guideline for someone carrying one baby who starts pregnancy at a healthy weight is 25-35 pounds. If pregnancy starts out underweight, then the guidelines allow for higher weight gain, and the guidelines are lower for a pregnancy that starts out overweight.

Gaining too little weight has risks including that baby will have a low birthweight, and it is tied to premature labor. Babies who are smaller seem to have a harder time thriving after birth, requiring more frequent feedings than a baby who is born at a healthy weight. Gaining too much weight also is associated with risks such as gestational diabetes, preeclampsia, postpartum hemorrhage, and baby's blood sugar may drop too much after birth.

I want my clients to gain weight. I don't have "rules" about how much should be gained during pregnancy or when weight should be gained. I don't have a scale in my office to weigh clients. I figure we all have enough stress about our weight without the need to stand on a scale at appointments. 

I want clients to eat enough nutrient dense food to support their body and pregnancy. I rely on non-scale ways to ascertain if a client's diet is supporting pregnancy well. I use assessments like how fundal height is increasing, and how baby feels when I palpate. I also observe how clients look, if they feel well, and if they are having any issues such as swelling as pregnancy progresses. I like to see a food log at the start of prenatal care, and I like to see one again around 30 weeks. Some of my clients find it really helpful to keep a food log as a way to help keep the focus on eating nutrient dense foods.

I understand the desire not to gain more weight than needed for a healthy pregnancy. I work with clients to encourage them to eat nutrient dense foods, and recommend foods they may want to add or focus on if they experience cravings. If a client is eating primarily nutrient rich foods during pregnancy and engages in regular exercise, I believe she will gain the amount of weight her body needs to sustain that pregnancy. 

While encouraging clients to eat nutrient dense foods, we focus on ways to make that sustainable and enjoyable. After all, if you don't like it, you won't keep doing it. We are all individuals and while there are recommendations about weight gain, they may or may not be appropriate for the client. I do not believe in a one size fits all approach to maternity care, and I certainly do not believe a one size fits all approach is appropriate for pregnancy weight gain.