The thyroid gland, a butterfly-shaped organ located in the neck, is a vital part of the endocrine system. It produces hormones that regulate the body's metabolism, which is the process of converting food into energy.  Here's how it works: 

• The thyroid gland produces two main hormones: thyroxine (T4) and triiodothyronine (T3).
•  T4, or thyroxine, is like a storage form of thyroid hormone. It circulates in your blood, but it's not the active form that your cells can use. To become active, T4 needs to be converted into T3. This happens mainly in your liver and kidneys, but also in other tissues throughout your body.
• The conversion process involves removing one iodine atom from the T4 molecule. This is done by enzymes called deiodinases. There are different types of deiodinases, and they work in different parts of the body to regulate how much T3 is produced.
• Once T4 is converted into T3, it can enter your cells and bind to receptors, triggering all sorts of important metabolic processes.                                                                                                                               

Why is the thyroid so important during pregnancy?
Your thyroid produces hormones that regulate metabolism, which is essential for energy production and overall body function. During pregnancy, your body's demand for thyroid hormones increases significantly. This increased demand is driven by several factors:

• Baby's Development: Your baby relies on your thyroid hormones for healthy brain development, especially in the first trimester when their own thyroid isn't fully formed. These hormones are crucial for neurological development, impacting everything from intelligence to motor skills.
• Maternal Health: Adequate thyroid hormone levels are essential for maintaining your own health during pregnancy. They play a role in energy levels, weight management, mood stability, and preventing complications.
• Placental Function: The thyroid also supports the healthy function of the placenta, which provides essential nutrients and oxygen to your baby.

What happens to the thyroid during pregnancy?
During pregnancy, several changes occur to ensure adequate thyroid hormone levels:

• Increased Hormone Production: Your thyroid gland naturally increases its production of thyroid hormones to meet the demands of pregnancy.
• Increased T4 to T3 Conversion: The body becomes more efficient at converting T4 (the storage form) to T3 (the active form) of thyroid hormone.

What are the most common thyroid problems during pregnancy and what issues are associated with them? 
Hyperthyroidism: This condition occurs when the thyroid gland produces too much thyroid hormone, speeding up many bodily functions. In pregnancy, hyperthyroidism is most often caused by Graves' disease, an autoimmune disorder where the immune system produces antibodies that stimulate the thyroid to make excess thyroid hormone. During pregnancy, untreated hypothyroidism can lead to complications such as preeclampsia, premature birth, low birth weight and neurological issues in baby.
Hypothyroidism: This condition occurs when the thyroid gland does not produce enough thyroid hormone, causing body functions to slow down. The most common cause of hypothyroidism is Hashimoto's disease, an autoimmune disorder where the immune system attacks the thyroid, impairing its ability to produce thyroid hormones. Untreated hypothyroidism is associated with an increased risk of miscarriage, preeclampsia, placental abruption, postpartum hemorrhage,  premature birth, low birth weight, stillbirth and transient or permanent hypothyroidism in baby.
What are the treatments for thyroid problems during pregnancy?
Levothyroxine is used to treat hypothyroidism during pregnancy. If you are already taking Levothyroxine, you may need to increase your dose.  Thyroid levels should be checked every 4 weeks during pregnancy. 
Natural thyroid hormone options like Armour Thyroid, which contain T3, are not recommended during pregnancy because they can cause lower levels of T4 in the maternal blood stream. Baby needs T4 so having lower levels will lead to decreased T4 available for baby and can lead to baby having hypothyroidism.
What can you do to support healthy thyroid function during pregnancy?

• Ensure adequate iodine intake: Follow your doctor's recommendations regarding iodine supplementation. Prenatal vitamins often contain iodine. Include iodine-rich foods like seafood (in moderation), dairy, and iodized salt in your diet. However, it's important not to overdo it with iodine, as too much can also be problematic.
• Maintain a balanced diet: A healthy diet rich in essential nutrients supports overall health, including thyroid function.

Sources:
https://www.hopkinsmedicine.org/health/wellness-and-prevention/anatomy-of-the-endocrine-system#:~:text=The%20thyroid%20plays%20an%20important,of%20the%20body's%20calcium%20balance
https://www.ncbi.nlm.nih.gov/books/NBK500006/#:~:text=The%20thyroid%20hormone%20is%20well,and%20many%20other%20bodily%20functions
https://www.ncbi.nlm.nih.gov/books/NBK537039/#:~:text=The%20thyroid%20produces%20approximately%2090,%2C%20or%20triiodothyronine%20(T3)

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What is GBS?
Group B Strep (GBS) is anaerobic bacteria that is usually found in the digestive tract. In 10-30% of pregnant women, it can colonize or grow in the vagina.

Why is GBS a concern during pregnancy?
Most women carrying GBS will have no symptoms. Carrying GBS is not harmful to you, but there is a small chance it can affect your baby around the time of birth.

How will I know if I have GBS?
GBS is detected by doing a vaginal swab and running a culture.  The recommendation is to test between 36 to 38 weeks gestation.

If I test positive for GBS, will I still have GBS when my baby is born?
GBS is transient so your status can change.  Up to 33% of women who test positive at 36 weeks may be negative at birth, and up to 10% of women who test negative at 36 weeks may be positive at birth. Without doing a rapid test (which is not the standard of care in the US), GBS status at the time of birth is unknown. For the clients I serve who test positive at 36 weeks, they have the option to repeat the test to see if their status has changed.  

What are the risks of GBS to my baby?
GBS can occasionally cause serious infection in newborns. Many babies come into contact with group B Strep during labor or around birth, and the vast majority will not become ill. Of Moms who test positive for GBS and choose not to have antibiotic treatment, up to 2% of babies born will develop a GBS infection. For Moms who test positive and choose to have antibiotic treatment, the risk of baby being infected drops down to .2 to .4%  If the GBS infection is not treated, babies can become seriously ill. With prompt treatment, most babies will make a full recovery, a small number of babies who are infected die. Early detection of GBS disease is vital so treatment can be started as soon as possible.

The two main types of GBS disease in newborns are:

• Early-onset GBS disease: Occurs within the first week of life and is more common. This is what GBS testing is focusing on preventing.
• Late-onset GBS Disease:Occurs 1 week to 3 months after birth and is less common.

How many babies die from early onset GBS disease?
Two to three babies (4 to 6%) out of 50 babies with early onset GBS disease will die.

What are the symptoms of early-onset GBS infection in newborns?

• Being floppy and unresponsive
• Grunting when breathing, or working hard to breathe when you look at their chest or tummy
• A high or low temperature
• Very fast or slow heart rate
• Very fast or slow breathing
• Crying and inconsolable

The overwhelming majority of babies with early-onset GBS disease are diagnosed within the first hour after birth, which indicates the baby was most likely infected before birth.

What is the treatment for GBS infection in babies?
The treatment for GBS infection in babies depends on the severity of the infection. Antibiotics are the main treatment for GBS infection. Antibiotics do not discriminate between strains of bacteria, so if you get IV antibiotics during labor, or your baby is given antibiotics after birth, I recommend taking probiotics to rebuild a healthy microbiome.

In Summary:
While the risk is low of a newborn getting a GBS infection, there is a risk and I want clients to be aware of that. I don't want any client to have a baby who gets GBS disease. I cannot provide antibiotic therapy, so if that is desired, we will work to transfer care for a hospital birth. I trust that clients are capable of weighing the risks and benefits and making the decision they are comfortable with and is best for their family. I will monitor baby for signs of GBS infection and make sure the client knows what to look for and how to access help if baby needs it.







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Pregnancy and exercise are not mutually exclusive.  Yes, pregnancy does require some lifestyle changes as the pregnancy gets farther along like not sleeping on your back, but being pregnant does not relegate you to invalid status.

Exercise and pregnancy go hand in hand. The benefits of exercise during pregnancy are significant.

• Reduced constipation
• Better sleep
• Helps to keep weight gain at appropriate levels
• Increased strength and endurance
• Reduced risk of gestational diabetes
• Reduced risk of high blood pressure
• Helping baby settle into a good position for birth
• More energy
• Stress reduction
• Improved mood

Pregnancy is a perfect time to start exercising regularly if you haven't been working out.  Walking is a great place to start, although you can start with just about anything like having a dance party with your kids, or raking leaves.  Build up gradually until you are working out for at least 30 minutes 5-6 days a week.  If you are already working out, you may want to modify what you do.  For example, if you are doing heavy weight lifting, consider using lighter weights and more reps.  Be mindful of avoiding exercise that puts you at risk of falling such as mountain climbing, or contact sports such as hockey.  Also modify abdominal exercises to reduce the chances of diastasis recti.  

I encourage all the clients I serve to exercise because the benefits are too great to miss out on. Labor and birth require strength and endurance. Regular exercise will go a long way to help with being prepared for the demands of labor and birth. 
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Today, I'm going to rant a little.  One of my personal pet peeves as a midwife is that once it is obvious that someone is pregnant, it is as if they become public property.  Complete strangers suddenly feel as if they have carte blanche to comment about your pregnancy, your choices, your health and so on.  Sometimes they feel that pregnancy entitles them to come over and touch your belly without asking first!  You may get told birth stories whether you want them or not.  

Why does it seem to so many that it's acceptable to comment on a stranger's pregnancy.  Comments like "You look ready to burst", or "I hope your water doesn't break while you are shopping" are often shared when someone sees a pregnant mother.  It's sad that people just can't keep their comments to themselves.  

A large proportion of society seems to have the tact to restrain comments on someone's appearance while with them in person (social media is another matter) unless it's a pregnant mother.  We don't walk up to strangers and tell them how to take care of themselves unless it's a pregnant mother.  We don't tell siblings that their lives are never going to be the same, that they will have to grow up unless they are with a pregnant mother.  We keep our comments to ourselves unless it's about a pregnant mother.

We need to stop making comments, expecting we can pat bellies, and giving unsolicited advice.  What if we kept our mouths shut and didn't share unless asked?  What if we shared a smile with the pregnant mother and went on with our day knowing we made her life easier by smiling instead of assuming we have something to say she wants to hear?