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.

Being a midwife can be challenging, and it requires many skills. One of the skills I have had to hone as a midwife is juggling....

Being a midwife means being an expert in calendar juggling.  Scheduled commitments and activities may get canceled at the very last minute, or rearranged a few times depending on when babies decide to come.  Being a midwife means being dependable for clients, occasionally at the expense of your friends and family.  Sometimes you have to put the needs and desires of your family second. Yay for flexible families and friends who understand this and support the midwife wholeheartedly!

Sometimes being a midwife means juggling vehicles.  In my life, we have an older car which is fun to drive but isn't the car you want to drive for longer distances.  If the hubby needs to travel, we have a discussion about where my clients are located to decide which car he's taking.  Sometimes he may come and switch out cars while I'm at a birth.  

Being a midwife means you may juggle your own needs so you can support a client in labor.  I've been at many births where my needs for sleep, eating or drinking were shifted or delayed so I could be available to support a client in labor.

Being a midwife means trying to juggle the expectations you have of yourself, the expectations your clients have, and expectations others who are invited into the birth may have. Trying to juggle expectations means I am forever second guessing myself. I always wonder if I have missed something, if I am understanding what I can see, feel and observe correctly.  I am not perfect and know I will make mistakes, but I keep chasing after perfection. 

Don't misunderstand me, I am not complaining. I chose to be a midwife. I have impressed myself at times with the juggling that is part of midwifery.  Maybe one day I'll even learn to juggle balls or fruit!

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?

There are lots of ideas and suggestions for ways to navigate labor. You can find ideas on Instagram, Facebook, blogs, in books, from talking with friends and family and sometimes total strangers will feel the need to tell you what you can do. These suggestions and ideas may work for you, or they may not.  I have a personal favorite suggestion I share with all my clients that I think will benefit every one during labor.

My personal favorite tip is:

                            Ignore labor as long as you possibly can!

That's it, that's my favorite tip!

In order to finish labor strong, you need to have something in reserve to pull from. I want clients to still have something in the tank as they start recovery and postpartum.  If labor starts and it is your normal bedtime, go to bed. If labor has started and it's the time you normally go for a walk, then go for a walk. If you are in labor and you have a lunch get together scheduled, go to lunch.

I anticipate that labor for a first baby will take 24 hours, and I anticipate 8-12 hours for susbsequent babies.  Everyone wants a short labor, but short labors are the exception. How long labor will last is always unknown until it is finished so I think preparing for a long labor is wise. The best thing a Mom can do when labor starts is ignore it. Yes it's exciting to know that labor is finally happening and that you will meet your baby, however saving your energy and attention will pay off big when you are running on more than adrenaline after birth.

If your labor starts, and you are timing every single contraction. If labor is happening and you stay up through the night trying to make it progress. If labor is going and you put your life on hold. If labor is progressing and you don't make space to rest. You will be exhausted by the time it is over. When you give labor all your attention before you can't ignore it, you most likely won't have anything in reserve when you need it. Ignoring labor as long as you possibly can takes less of your energy, and sets you up to finish strong.

I had my hospital births a good number of years ago.  Since then I have learned so much as I worked as a doula, and later as I began my midwifery practice.  When my babies were born, doulas and lactation consultants were not a thing, and midwives were rare.  Laboring in a hospital bed on your back while hooked up to an IV was expected for hospital birth.  If I knew then what I know now and what is available today was common then, I'd do things differently.
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• I would have a doula.
• I would  be up and moving instead of laying in bed.
• I would labor using water for comfort, preferably in a tub.
• I would eat more than ice chips.
• I would labor at home, and wait before heading to the hospital.
• I would go to LaLeche League meetings, read books and watch vidoes on breastfeeding to be better prepared to nurse my baby.
• I would be less of a "good" patient and more of an advocate for myself.
• I would ask questions to better understand the risks and benefits of my options during labor.
• I would take a childbirth class such as a Bradley class in addition to the hospital class.
• If was an option back then, I would use a midwife and plan on a home birth.
• I would come home and spend the first 4-5 days snuggling with my baby and not doing anything besides nursing my baby and sleeping.

The changes I would make are changes that empower women in labor, and support them in a way that does not restrict choices.  They are the changes that I incorporate into my midwifery care and that I have many conversations with my clients about.  I want my clients to ask questions, to eat and drink during labor, to move how their body tells them to move, to be prepared for breastfeeding, and to have good labor support.