What is Hemoglobin?
Hemoglobin is found in your red blood cells.  It is a protein your body makes from iron, and is what holds oxygen to transport it around your body to cells and organs.

How do I get the iron my body needs to make hemoglobin?
Food is the best source of the iron your body needs to make hemoglobin.  Remember being told as a kid you should eat liver?  Well, pregnancy is the time to take that advice.  For those who just can't handle liver (including me), red meat such as beef, buffalo, venison etc are the next best source.  Dark chocolate is a good source too.  The darker the chocolate, the higher the iron content.  Lots of foods have iron, so read labels and do some research online.  Be mindful that calcium will block iron absorption, so if you are needing to increase your hemoglobin, think twice about adding cheese to your hamburger.  On the other hand, Vitamin C will increase iron absorption so you can feel good about enjoying some dark chocolate covered strawberries.  Make sure you have are getting folate since iron needs this as well as Vitamin C to do its job.  If your iron has dropped at around 30 weeks gestation, good job expanding your blood volume!  You have time to get your hemoblogin back up to a healthy level before birth. 

What should my hemoglobin level be?
In the first prat of pregnancy, hemoglobin levels should be 12-15 g/dL.  As your blood volume expands, this number drops, usually by 2 g/dL.  This drop is due to your iron being diluted by the increased amount of blood in your body.  I prefer my clients have a hemoglobin level of at least 11 g/dL before the baby is born.  This will help Mom handle blood loss from birth well and lets baby build iron stores.  Iron transport accross the placenta to your baby is highest in the last 4 weeks of pregnancy.

How will I know if my hemoglobin levels are low? 
You may notice fatigue, brittle nails, pale skin, dizziness, shortness of breath and heart palpitaiton or rapid pulse.  I like to check hemoblogin at around 30 weeks gestation so we can see how much of a change there is, and so there is time to get it back into a healthy range.  

What should I do if my hemoglobin levels are low?
I recommend my clients focus on iron rich food while being mindful that sources of calcium will block absorption and vitamin C will increase absorption.  Depending on what lab work indicates, I sometimes recommend supplemental forms of iron and sometimes Folate to help raise levels.  It takes about 2 weeks before any increases will shop up in labwork, although often clients will notice an increase in energy, or a lower heartbeat after just a few days  of working to raise iron levels.  Depending on how much the level has dropped and how a client is feeling after working to raise levels,  I may check it again around 36-37 weeks gestation.

​Hemoglobin is critical for your baby, and for your body.  I expect hemoglobin to drop in pregnancy, and I actually find it more concerning when the level doesn't drop. Monitored through your pregnancy,  hemoglobin levels are very easy to address with simple changes in diet.
 
               



​

Manhattan, Kansas is a highly mobile community.  With college students and military familes here, there is always someone leaving the area and someone who just got here.  In working with my clients, I realized that even lifelong Manhattanites sometimes need some fresh ideas of things to see and do in the area.  After doing a prenatal with a client who arrived a month ago who was still learning about the area, I realized I could help her by making a list of places to go and things to do.  

Travel guides are helpful.  Whether in book form, or online they can give you ideas that may appeal to your family.  I have found though that often they are repeating publicity information from the place itself, or rehashing what was in a travel guide from years ago.  We all appreciate hearing personal experiences and I find those more helpful.

Being married to a Soldier, my family has lived all over the place.  Once thing we realized early on is that sooner we started exploring, the sooner we started having fun.  One of my favorite ways to explore was to drive around and get lost.  Often this would be helpful when out with the hubby and realizing I'd been lost there before and knew my way around.  We loved checking out the local museums and trying to find the things to do that were off the beaten path.  

I've made my list of things to do and want to share it here.  I've been to every place on the list except two, but included them based on my friend's experiences.  I share my opinions about what age range the place is better suited for and things my family really enjoyed about it.  I hope you and your family enjoy exploring these places as much as mine did.  Please share my list and let me know your experiences and other places I should add.  Remember to check on any Covid related changes or restrictions at each place before you go. You can get the list here.

When I had my sons, we did not have family close by and had a handful of friends we had made between births that we had just moved 40 minutes away from.  I had no posptartum support after my first child.  Postpartum support after my second child consisted of a friend providing one meal and another friend sending a balloon bouquet to big brother.  I've thought a lot about those days and ways family and friends who are far away can help with supporting the family in the postpartum period. In serving Manhattan KS and surrounding areas with a highly mobile military and student population, I want to share my ideas so family and friends who aren't local can help provide some postpartum support.  

• Give gift cards for restaurants.
• Give gift cards for Ubereats, Doordash or other delivery services.
  • Helpful for those times when making a meal is just too much to manage.
• Pay for a meal service like HelloFresh or Freshly.
  • Some services offer allergy free options which is great for families with food allergies/sensitivities.
• Pay for lawn mowing services.
• Pay for a few sessions or a few months of housecleaning.
• Mail a package for siblings with books, snacks, toys etc.
  • Not only will big brother or sister be excited to get a package, having something new will keep them occupied, hopefully for a few days.
• Check in on a regular basis to see how Mom, Dad and family are doing.
  • Be mindful to listen well and not be judgemental or offer advice unless asked.
• Be available whenever Mom or Dad needs to vent by phone or video chat.
  • Sometimes we just need someone to listen and acknowledge they heard us.
• Be available for a video call or phone call when Mom is nursing, or parents need a break/distraction for siblings.
  • I once desperately needed a break so I called my husband on his lunch break at work. He was not in but his coworker who answered the phone was willing to sing the ABC song with my toddler for 10 minutes which gave me a much needed chance to step away and take a few deep breaths.
• Consider asking local friends in the area to join a meal train, or schedule a time to stop by and do a quick chore like starting laundry or loading the dishwasher.
• Offer to read a story over the phone or  by video call to baby and/or siblings.
  • This could become a regular thing that everyone looks forward to.

I hope these ideas help friends and family who aren't close by to be able to share in the joys and work of the postpartum period.  I know how hard it is to be far away from loved ones and how nice it is to be able to do something to help.  Being able to help will let you be more connected with the postpartum family and believe me, every bit of help is deeply appreciated.  I will never forget Brett's kindness in singing with my toddler, or how excited my son got when packages from Grandma who lived accross the country arrived.   

Let me know what ideas you have in the comments below and I'll be sure to add them to my list.   Here's a printable version to share with friends and family.

Researchers are testing a new pill to treat postpartum depression.  I am happy to hear there will be more options for those who have postpartum depression.  However, I see the same pattern again.  Mainstream medical care focuses on treating the symptoms, but it isn't all that proactive at addressing the causes. 

Postpartum depression affects the entire family, not just Mom.  It is estimated that up to 25% of partners will suffer with postpartum depression, and that number skyrockets to 50% if Mom has postpartum depression.  In 2018, the results of a study done in the United Kingdom shows that postpartum depression affects the children in the home.  The children have developmental delays, higher rates of behavorial problems, are more likely to drop out of high school and are more likely to struggle with depression in the teen years.  Postpartum depression has a ripple effect that can last for years and affects more than just the mother.

Outcomes would be better, recovery times would be shortened and families would be healthier and happier if we gave priority to eliminating or reducing the causes of postpartum depression instead of developing an IV treament or pill to treat the symptoms of postpartum depression.  From an economic standpoint, heading off postpartum depression before it starts would reduce health insurance costs, and keep the family from having decreased earnings as a result of the family having to navigate life when one or more members is dealing with postpartum depression.  

What would happen if we actually supported women and families during the postpartum period?  What if we talked about what to expect in the postpartum period instead of glossing it over?  What if we normalized that postpartum can be a challenging time?  What if we sent midwives to check in with mothers before the six week appointment?  What if we did more than a phone call in the first few days after birth to check on the family?  What if support for new families involved more than a meal train the first week or so?  What if someone came in a few hours a day to do laundry, dishes, floors, and maybe stay with baby while the parents get a shower and take a nap?  What if our country decided to join the rest of the industrialized world and instituted a national policy requiring paid parental leave?  What if we stopped focusing on the short term costs, and started focusing on the long term benefits of investing in and supporting new and growing families?

Postpartum is a wonderful, challenging time.  As a midwife, I try my best to help families smooth out the rough spots and manage the challenges.  I am a huge fan of postpartum planning.  Doing more postpartum visits than just the one at 6 weeks is one way I am making a difference.  Checking in more lets me assess how well mother is recovering, and to monitor for unwelcome things like postpartum exhaustion, anxiety and depression.  Being able to catch these things early is key to keeping mothers and families safe and healthy in the postpartum period.  There is a saying that an ounce of prevention is worth a pound of cure.  I agree and as a home birth midwife,  I feel I am making a difference by focusing on prevention so families don't have to suffer while they wait for a cure to kick in.

​

Postpartum is a truly unique time with both challenges and exquisite joys. Movies and TV shows perpetuate the myth that postpartum is a time of great happiness and joy, while making light of the less pleasant aspects. We don't have a lot of conversations about the reality of postpartum life, and reality and fiction rarely match up.

Postpartum can be challenging.  Mom and Dad are adjusting to having a new family member who is totally dependant on them for everything.  Mom is facing the reality if she is breastfeeding that she is the 24 hour  all you can eat buffet for baby.  Mom is also dealing with being sore from labor and birth, having bleeding and maybe leaky breasts that turn on and off at random when baby isn't nursing.  Dad is trying to figure out how best to help Mom while learning that there are some problems that he can't fix for Mom.   Both parents are navigating all this while in a very sleep deprived state, and may be getting all kind of conflicting advice about sleep, feeding, holding baby etc from friends, family and caregivers.  

Don't get me wrong, postpartum can be wonderful.  Baby is here and Dad can finally touch and hold him or her.  There's nothing to match the feelings of seeing your baby's first smile, or hear that first belly laugh, not to mention the delight in locking gazes with baby. There is a special joy in knowing someone is so dependant on you and that you can take care of them.  

There are things you can do to set yourself up to have an easier postpartum, or fourth trimester.    One of the most important things you can do is to have help available for the first 2-3 weeks postpartum.  Maybe a family member stays with you and helps with meals, cleaning and all the household duties so the parents can focus on baby and recovering from pregnancy and birth.  Some families hire a postpartum doula to help, or they have someone arrange for a meal train, and use delivery services for groceries, diapers and other necessities of life for the first few weeks.  Having some easy to prep meals, or freezer meals on hand is another great way to prep for postpartum.  Having a diaper changing station, or basket with all the diaper necesseties to keep close at hand when baby is here, as well as a snack station for mom are other ways to make postpartum a little easier, especially if you are not able to arrange for someone to always be around in the first few days and weeks.  

You get to decide what you want your postpartum time to look like.  Maybe it includes things like dates and times you will be able to receive visitors. I personally recommend that any visitors have a job do to like laundry, cooking, dishes etc as part of the visit (you could have a list of things you want help with for visitors to pick from).  Maybe there's a scheduled time for Dad to go hang out with friends, or Mom steps out to get a pedicure.  Maybe you have a list of older siblings' favorite games, movies, or places to visit for friends and family who want to help with siblings.  The options are endless, so think through what you feel you will need, and what you want.  Consider making a written postpartum plan which can help with communicating your needs and desires with others.  You can share it with family and friends who are going to be part of your support team.  Remember, it is your postpartum and not anyone else's so do what you need to do to have the postpartum you need and want.