Podcast Episode #357: Prenatal Health, Pregnancy, & C-Section Recovery with Meg the Midwife

Topics

1. Introducing our guest, Meg the Midwife, Meg Reburn [2:02]
2. Something new that I'm digging lately [5:32]
3. Meg's professional career as a midwife in Canada [8:30]
4. Recovering from hypothalamic amenorrhea and getting pregnant [14:21]
5. Prenatal recommendations [23:27]
6. Low basal body temperature [27:10]
7. A journey of balance versus healing [37:10]
8. Turning a breech baby [43:29]
9. Recovering from a C-section [47:38]
10. When baby measures “big” [59:23]

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You’re listening to the Balanced Bites podcast episode 357.

Liz Wolfe: Welcome to the Balanced Bites podcast. I’m Liz; a nutritional therapy practitioner, and author of the Wall Street Journal bestseller Eat the Yolks; The Purely Primal Skincare Guide; and the online program Baby Making and Beyond. I live on a lake in the mystical land of the Midwest, outside of Kansas City.

I’m the co-creator of the Balanced Bites Master Class with my podcast partner in crime, Diane. And together we’ve been bringing you this award-winning podcast for more than 6 years. We’re here to share our take on modern healthy living, answer your questions, and chat with leading health and wellness experts. Enjoy this week’s episode, and submit your questions at http://blog.balancedbites.com or watch the Balanced Bites podcast Instagram account for our weekly calls for questions. You can ask us anything in the comments.

Remember our disclaimer: The materials and content within this podcast are intended as general information only, and are not to be considered a substitute for professional medical advice, diagnosis, or treatment. Before we get started, let’s hear from one of our sponsors.

Diane Sanfilippo: We are thrilled to announce a brand new sponsor to the podcast this week, Kettle and Fire. We’ve talked about bone broth before and the many benefits, but to name a few, it’s been shown to reduce inflammation, improve digestion, and improve the quality of your skin. While I do like to make my own bone broth, there’s not always time for that. Kettle and Fire is the next best thing. They use organic chicken bones, and a slow simmer time to extract as much protein as possible. Not to mention that they use chicken feet; yay! Which increases the collagen and gelatin. And you can store it directly on your shelf for up to two years. Which is pretty cool, considering they’re a fresh, never frozen broth with no added preservatives or additives. Check them out at www.KettleandFire.com/BalancedBites and use coupon code BalancedBites for 10% off, plus free shipping. That’s one per customer. It’s 10% off, and free shipping.

1. Introducing our guest, Meg the Midwife, Meg Reburn [2:02]

Liz Wolfe: Alright, friends. It’s Liz here. Diane is taking a break this week. And I’m going to be interviewing one of my favorite people in the whole entire world, about one of the subjects we get asked about most frequently. And of course, about a topic that we have a program coming out relatively soon. So I’m really excited to have her back on again. The wonderful Meg the Midwife; Meg Reburn. She’s back on the show with me to chat about Baby Making and Beyond, and answer your questions.

Hi friend!

Meg Reburn: Hi, friend!

Liz Wolfe: So glad you're here!

Meg Reburn: Thanks.

Liz Wolfe: Where are you right now?

Meg Reburn: I’ve been traveling a lot lately. I’ve been taking a little break from my full-time baby catching practice. I once met a midwife who said for every 10 years you practice on-call, you should take 6 months to a year off. So I am doing that. I’m just seeing some coaching clients, and I’ve been traveling a lot. And right now, I’m in wild northern Ontario, on an island in Lake Huron, where my family has a little cabin. So that’s where I am.

Liz Wolfe: I feel like every time I talk to you, you're either somewhere different, or preparing to go somewhere different.

Meg Reburn: I know. I’m enjoying some traveling. Because on-call life doesn’t really let me travel as much as I want to. So I’m seeing a lot of friends and family that have been neglected over the last 10 years. So it’s nice.

Liz Wolfe: Yeah. I love that.

Meg Reburn: Taking care of myself, and practicing what I preach.

Liz Wolfe: Good! That’s hard to do.

Meg Reburn: It is hard to do!

Liz Wolfe: Alright, so I’ll give folks a quick background on you. Meg was on the show in 2016. {laughs} Which; wow. I can’t believe that was 2016. I thought that was like last year. But we’re in 2018. That is crazy.

Meg Reburn: Time flies.

Liz Wolfe: Yeah. So if you want to hear more, check out episodes 261 and 263. Meg hails from the great white north, and hangs her hat in British Columbia, Canada. She is a registered midwife, and we’ll talk a little bit about what that means. Pregnancy educator, women’s wellness coach, writer, and former faculty member at Mt. Royal University.

Meg has a bachelor of science with honors in health, and has a special interest in both functional nutrition, women’s hormone balance, and nutrition for female athletes. And you are one. Would you call yourself an endurance athlete?

Meg Reburn: Yeah. My athletic pursuits kind of ebb and flow. But right now I’m doing a lot of ultra running, and a little bit of climbing in between there.

Liz Wolfe: Pretty awesome. So Meg is currently working with women both as a midwife; well she’s taking a little break as a midwife. But she has been working with women both as a midwife and as a wellness coach. She likes to call her style of practice an evolutionary approach, believing that the body has the innate wisdom to care for and balance itself, given the proper time, attention, and care.

When not busy with work, Meg creates space to do the things that she enjoys. These days, that takes the form of long distance trail running, swimming across big scary lakes, rock climbing, and general mountain adventuring. It’s her jam to help women find their healthy balance so they can feel great and do more of what makes their heart sing. I love that.

Meg Reburn: Thanks.

Liz Wolfe: You're going to have to come swim across my big scary lake.

Meg Reburn: I plan on it! I’m excited. {laughs}

Liz Wolfe: It’s going to be awesome.

Meg Reburn: I’ll warn you, though. I wear some dorky goggles, and a pretty nerdy wet suit. So it will make for some good photos. I horrify teenagers regularly.

2. Something new that I’m digging lately [5:32]

Liz Wolfe: It’s all good. Let’s do a quick something new I’m digging segment. I didn’t warn you about this, I don’t think. You're going to have to jump in on this too. Something new I’m digging. My something new that I’m digging is freeze dried strawberries as “treats”; finger quotes, for my daughter. It’s kind of like; I was a little worried they would ruin strawberries for her. But it seems like a pretty decent compromise when she wants a treat. And she thinks it’s something really special and amazing, and all it is is freeze-dried strawberries. So that’s my new thing.

Meg Reburn: Oh, that sounds good.

Liz Wolfe: Yeah. What about you?

Meg Reburn: Let’s see. I have really been digging this new; well, it’s new to me. Maybe it’s not new to people in America. But because I’ve been traveling in America a lot, I’ve been enjoying many of your fantastic snacks that we don’t have in Canada. And I discovered; I think it’s called Gut Punch. It’s by Farmhouse Culture. And it’s a cola. It’s not a traditional cola. It’s essentially like cabbaged juice that’s been repurposed into a delicious probiotic beverage.

Liz Wolfe: That sounds horrific.

Meg Reburn: And that’s just it; it is kind of horrific, and it took me maybe three bottles to decide I liked it. But I was so curious by it, I had to keep drinking it. And now I’m totally addicted to it. So that’s what I’m digging.

Liz Wolfe: Interesting. And when I say horrific, I mean that in the best way. Like, I’m completely fascinated and want to try it type of way.

Meg Reburn: Well they mix it with beets. And cabbage juice and beets doesn’t sound like cola, but it actually kind of tastes like it. It’s pretty good.

Liz Wolfe: Where did you stumble across that?

Meg Reburn: I think I came across it at like a food coop in Washington. But they have it everywhere. I’ve seen it at Whole Foods. You just have to look for it. It’s where the kombucha and water kefir lives.

Liz Wolfe: See, we are living in an era where repurposed cabbage and beet juice is something that’s viable to be sold at Whole Foods. It’s like; I feel like I have some hope.

Meg Reburn: For ridiculous prices. But I’m a sucker, and I love it.

Liz Wolfe: The Balanced Bites podcast is sponsored in part by the Nutritional Therapy Association. The NTA trains and certifies nutritional therapy practitioners and consultants (including me; I’m an NTP), emphasizing bio-individuality and the range of dietary strategies that support wellness. The NTA emphasizes local, whole, properly prepared nutrient dense foods as the key to restoring balance and enhancing the body’s ability to heal.

The NTA’s nutritional therapy practitioner program and new fully online nutritional therapy consultant program empower graduates with the education and skills needed to launch a successful, fulfilling career in holistic nutrition. To learn lots more about the NTA’s nutritional therapy programs, go to http://www.NutritionalTherapy.com. Don’t forget to check out their free Nutritional Therapy 101 course, and their brand-new course, Foundational Wellness, launching this summer.

3. Meg’s professional career as a midwife in Canada [8:30]

Liz Wolfe: Alright. So let’s get into questions. But first, I want to have you expand a little bit on your professional credentials. Because one of the things I think is so amazing about the work that you’ve done as a midwife in Canada; and that I feel like makes you uniquely able to give perspective on a ton of different birth options that we don’t have in the United States. Or, not that we don’t have in the United States, but that one provider cannot cover the span of birth experiences that you can as a midwife in Canada.

I wanted you to kind of expand on that. And the way I usually; when I talk about you to people, which is often. I often say, as a midwife in Canada, she has worked not only in hospitals. You have C-section moms. But you’ve also worked in the home-birthing environment. And I think that’s really amazing. So can you expand on that a little bit?

Meg Reburn: Yeah, for sure. Midwives in Canada; we kind of have the best of both worlds up here. We are primary care providers. It means that we don’t work with or under the supervision of a physician. We just kind of work independently. We care for low to moderate risk women, both in their homes if they choose to have a home birth, or in the hospital. If they’re choosing a hospital birth or they have other risk factors that might mean that it’s safer for them to deliver in the hospital.

I personally have worked in a bunch of different practice settings. Everywhere from rural, primarily home birth practices, where you might be taking care of groups of Mennonite clients. Where you're taken to a birth in the middle of the night by a horse drawn carriage. Up to working in a big tertiary care hospital, where you're triaging women and fielding many pager calls a day and dealing with emergencies and delivering up to 7 babies in a 24-hour shift.

So I’ve kind of seen the gamut of birth and birth choices. And midwives in Canada, our scope of practice allows us to do a lot more than I think midwives do down in the states. So we can prescribe medications that perhaps you can’t prescribe down in the states. But we’re also trained in things like use of herbal medicines, homeopathy, and for some midwives, acupuncture, which is really cool. And we use those both in the home and hospital. So while a woman might be laboring in the hospital, perhaps she could benefit from some acupuncture in her labor. We can do that, which is really unique.

Liz Wolfe: Super cool. And one of the things I think folks don’t necessarily realize in the United States, even folks that live here, is that; I suppose you could say there are two different types of midwives. Home birth midwives in the United States are completely separated from hospital birth midwives. And that is kind of unfortunate that they’re unable to practice in certain ways, that they’re probably perfectly qualified to do. And that’s a commentary I’m not really educated enough to make.

But I just think it’s interesting that there are midwives; nurse midwives are able to work in hospitals, and often in conjunction with hospitals. For example, large hospitals in Kansas City also have midwife practices within them. So you’ll be seeing these midwives, and they’re backed by the OBs within those hospitals.

But there’s also one or two free-standing, birthing clinics that are technically backed by hospitals, but are free-standing. And they are also nurse midwives. And then there are certified professional midwives, and those are like home birth midwives. Many of them have medical training. Have extremely vast and many, many years of experience with birth. But they are only able to deliver women at home. So there’s just this kind of lack of cross talk between the two professions. Which is kind of a bummer.

And I know a lot of people are trying to very actively at least increase the cross talk, even if we’re not going to see professional midwives in the hospital setting. Actually able to guide their clients through labor and delivery. But it’s really cool to me that you're able to see both sides of that.

Meg Reburn: Well, and I think that’s where midwifery is headed in the United States. I’ve been talking to a few different midwifery groups down, south of the border. And there are some states where midwives do practice in a very similar way to Canada. I think New York state is one of them.

The big problem is that for women who might start off laboring at home, things happen during the course of a labor that might mean, hey it’s might be better if you deliver in the hospital. And it’s a real shame for those midwives, and for those women, who might have to transfer into hospital for some sort of intervention that both the provider and the woman feel is necessary, but they can’t have their provider follow them in.

Liz Wolfe: Mm-hmm. Yeah.

Meg Reburn: So here in Canada, if a woman. Let’s say her labor has totally petered out, or she’s has a really long first labor, and maybe her baby is posterior. She might benefit from some oxytocin or an epidural. The midwives in Canada here will follow her to the hospital, and then they’ll resume care, just in a different setting. Where as home birth midwives in the states, or in most states, they either have to leave women at the door. That happens in some states. Or they’re just in a supportive role, and not the primary care provider. Which is really hard for continuity, both for the providers and the women. It can create a lot of stress, and it’s really unfortunate.

4. Recovering from hypothalamic amenorrhea and getting pregnant [14:21]

Liz Wolfe: Alright. So clarifying that. Very good. Let’s start in with our first question. This came in through Instagram. This gal is recovering from hypothalamic amenorrhea, and would like to get pregnant as soon as her period returns. What are our tips?

Well, golly. What do you think Meg? I’m guessing that she has her plan for recovering from hypothalamic amenorrhea, and just wants specific advice about getting pregnant once her period returns. But maybe we should through in some tips about recovery from HA just in case she hasn’t quite figured that out yet. What do you think?

Meg Reburn: I think that’s a great idea.

Liz Wolfe: Ok. This is your wheelhouse, for sure. I know you’ve worked with women on this.

Meg Reburn: Totally it’s my wheelhouse. I’ve both worked with women with this, and I’ve struggled with it myself. I’ve spent a lot of time researching this. First of all, if she hasn’t already discovered, this woman named Nicola Rinaldi. She is fantastic. She’s a PhD researcher who has done so much research on this topic. She has a huge book called No Period, Now What? Which she should check out.

And also she started a couple of really supportive Facebook groups where women can share their experience, and just get the emotional support they need. Because it’s an incredibly emotional experience going through trying to get your period back. Because it often comes with some pretty difficult side effects to deal with. Such as a lot of weight gain, which is what a lot of women deal with, and is often the hardest part.

But, the big thing with recovering your period after a hypothalamic amenorrhea is you just need to eat more. You really need to be eating at least 2000 to 2500 calories a day. And for most women, they have to gain weight up to a BMI of sometimes 23, 24. So if she doesn’t know what her body mass index, or BMI is, she should throw it into an online calculator, and try to get up to that number. Because that seems to be the number at which most women will restart their cycles.

It doesn’t just magically reappear when you hit that number. You often have to sit at that number for a long period of time. Sometimes three months. Sometimes six months. And the reason for that is because the fat mass that you put on your body helps to produce estrogen, which naturally helps to restart your cycle. It also helps to help that little part of your brain, the hypothalamus, feel safe. And when it feels safe, all the other hormonal cascades that need to happen, happens.

So it stimulates your pituitary to make hormones that stimulate your ovaries to ovulate. And then once you ovulate, you create progesterone and you're back into a normal cycle. So the really big thing is to eat more calories. And to gain a little bit of weight. Which might often mean moving your body a little bit less. So doing a little bit less exercise.

I always tell women who come to me that need a little bit more help that if you're exercising vigorously more than 5 hours a week, you might need to cut that down to just gentle movement until your cycles return. When I say gentle movement, it seems to mean a lot of different things to different people. {laughs}

Liz Wolfe: {laughs} It doesn’t mean instead of one hour of CrossFit walk for five hours, right?

Meg Reburn: Yeah. That’s just it. You tell someone; “Just walk and do yoga.” Then some people really legitimately do that. They walk and just do mellow yoga. But some people walk for five hours and then go to hot yoga. And that’s not the effect we’re looking for. We’re looking for short gentle walks, which have been clinically proven to reduce stress hormones in the body.

Bonus points if you can go for a walk in nature. So get off the concrete. Walk in a natural setting. That’s been shown to reduce cortisol levels and increase all your happy hormones much more than going for a walk around the block. But if you can only go for a walk around the block, and that’s all that life is offering you, still go and do that.

And yoga just helps your body stay flexible and nimble. Maybe during a period of reduced activity. Plus it has the component of adding a little bit of an element of meditation and relaxation. Which will also help your body to feel safe and recover. That’s the big thing with HA. Your body needs to feel safe. Because for whatever reason, your cycles have stopped because it doesn’t feel safe enough to welcome a baby into the world. So the big thing is we have to make it feel safe in multiple different ways. So reducing exercise, increasing calories is usually the thing that restarts it for most people.

And of course, you want to look at other forms of potential stressors in your body. Do you have any food intolerances that could be contributing to it? Do you have any hidden autoimmune diseases that could be contributing to it? Have you had your thyroid checked? That’s another big thing. Periods can completely disappear if your thyroid is going a little bit wonky. So making sure that you're getting some medical follow-up and you’ve seen your doctor about these things.

You should also make sure that your prolactin levels aren’t too high. There is a rare, but not something I haven’t seen before, condition where there is a small benign tumor that sits on your pituitary gland that secretes prolactin. And we find this by doing a blood test to test for prolactin. And we find that your prolactin is sky high.

If your prolactin is sky high, that’s the breastfeeding hormone. People that are breastfeeding don’t get a period. And so it kind of tells your body that it’s breastfeeding and doesn’t need to have another baby. So it shuts of reproduction. So if we can find that out, we can usually treat it. So that’s another important thing to make sure that she’s done.

And then I get asked a lot about; “What supplements should I take?” The thing that I always tell people about supplements is they are just supplements. They supplement all the other things that you are doing. 90% of the time you can reset your cycles without taking any supplements. However, there are a few supplements that might be able to help. Vitamin C is a big one. It helps to buffer your body’s response to stress. Magnesium is also a really important one.

There is an amino acid called acetyl L-carnitine, which has some interesting research on it. It seems to restart cycles in about 40-60% of women who have done all of the other things. And when I say all the other things, they’ve gained some weight. They’ve rested. They’ve relaxed. It seems to help the body feel like it’s safe in whatever magical way that it does. They think that it acts on serotonin, dopamine, and beta endorphin levels. Helping your luteinizing hormone increase; which is the hormone you need to ovulate. So you could try some acetyl L-carnitine.

Other than that, a good probiotic is always a good idea, just to help with gut health. And that’s about it. But you know, if she’s thinking about getting pregnant, as soon as her period comes, making sure all of that extra food that she’s eating is incredibly nutrient dense. Not just, you know, eating pizza and French fries. Which is what most of us want to do when we’re recovering from HA. {laughs}

Liz Wolfe: {laughs}

Meg Reburn: But making sure it’s super nutrient dense so she is basically super loading her body with all of those good, fertility friendly nutrients.

Liz Wolfe: Yeah. One of the things that I’ve said once or twice before, is that a lot of times, folks who have super low body-fat also probably have super low nutrient stores. I don’t have any proof of that. I imagine if we actually did some testing we would discover that. Almost anybody can be low in their nutrient stores, but in particular folks whose body has been in that, I don’t know; what mode would you call it? Not starvation? Fight or flight maybe. Just that stress mode.

Meg Reburn: It’s a stress mode. It’s like a total fight or flight. If your body is underfed, it’s stressing out. It thinks that there’s a famine, and you're going to be depleted in multiple nutrients. Not just simple because you're not getting enough food. But because your body is demanding extra micronutrients. Because it’s stressed right out.

5. Prenatal recommendations [23:27]

Liz Wolfe: Yeah. So, as far as. Let’s throw out a couple of recommendations for potential prenatals for folks. Because if you are so much as thinking about getting pregnant it’s time to start up on a prenatal, I would say. I feel like I took a long time to actually land there. I spent a lot of time wishing people could do it all with food. {laughs} But I think that’s just not realistic. Liver three times a week is just not realistic.

So as far as prenatals go, I do like the one from Seeking Health. I’ve recommended it to people before. But the B12 in it is sky high. It’s one of those supplements that’s specifically created for people who are manifesting MTHFR mutations; as in, these mutations are actually affecting their body. Many of us understand that you can have a mutation. Not a mutation; it’s called a single nucleotide polymorphism. But you can have one of those, and it can be completely not manifesting at all in your life. Your body can crank out extra enzymes to compensate. But that’s no true for everyone.

So some folks do need those types of supplements. But I generally have recommended. Shoot, now I’m forgetting the name. I always forget. What is that one that I like? They just combined the parts one, two, and three.

Meg Reburn: Innate. It’s Innate brand.

Liz Wolfe: Yes! Why do I have such trouble remembering that?

Meg Reburn: {laughs}

Liz Wolfe: I always want to say Emerson, but that’s where you order it from.

Meg Reburn: That’s where you order from. That’s right. Innate brand is a wonderful one. And the Seeking Health one is great, but I agree. It’s more of a therapeutic based supplement. And I hate to use the word compliance, but that’s what we use in the medical world. Compliance is really low with it. Because I think you have to take six tablets a day to get the full dose.

Liz Wolfe: Eight!

Meg Reburn: Eight? Oh god. Yeah. So that’s tricky. But Innate, you have to take a lot fewer. It’s not a therapeutic grade, but it also has all of the methylated B vitamins. Which is the big thing to look for when you're looking at a prenatal. And it has a lot of other good stuff. Like, I think it has a good amount of choline and zinc in it, as well.

Liz Wolfe: It does have choline bitartrate. The only thing that I would say; you can agree or disagree, Meg. I think we align on most things. But it’s all good if you're not on board with me on this. But for the fertility time. And I don’t want to say this is appropriate for pregnancy, because that’s just one of those things that I don’t want to touch with this.

But I think within the fertility period, I think we’re pretty ok to say potentially some fat-soluble vitamin supplementation is appropriate for almost everyone. Something like some vitamin K2, vitamin D, and even vitamin A as retinol. Because one of the big downsides to the; dang it. Again. Emerson. Innate response prenatal, in my opinion, is that it derives all of its vitamin A from beta carotene. And I think a lot of the research we did for Baby Making and Beyond really revealed to us that that is probably not adequate for most people.

Meg Reburn: Mm-hmm. And I think a lot of supplement companies that are pumping out prenatals, they are very, very hesitant to add any retinol form of vitamin A. Because of that bad research that came out about vitamin A years ago. So for medical legal reasons, they won’t add it in. So adding in a little bit of extra vitamin A might be a good thing.

And those fat-soluble vitamins, I totally agree. I think it’s great to have extra of. Because those take the longest to build up proper stores of, too. Where as B vitamins, we put them in, and they go out just as fast as we put them in. There’s a quick turnaround with those.

6. Low basal body temperature [27:10]

Liz Wolfe: Yeah. Alright. Excellent. Let’s move on to the next question. This one is from Nicole. “Any recommendations if your basal body temperature is low? I have two kids, and I’m working on another. I’m usually around 97, and after ovulation, it goes to around 97.6. I’m assuming I need to get my thyroid checked, but I was wondering what else could be going on. Thank you.”

I’m just going to drop my thoughts on this, and then I’ll hand it over to you, Meg. We do know that there is, for some people, a hormonal component to low BBT, that maybe it means something more that you can go get checked out. She mentions thyroid testing. And Meg will talk a little bit more about the hormonal environment there that can impact that. But I also want people to know that sometimes there’s a completely other reason that you're BBT is under 98 on a regular basis. And that’s just one of those things.

I was able to raise my average BBT using some eating strategies. Basically {laughs} my fertility macaroon, is what I called it. Which was very interesting to me. Because I think what happens is we have that cortisol spike in the morning, cortisol can kind of throw other hormones out of balance. In particular, when you're having that spike in the morning, it wakes you up and you're not eating until 11 o’clock. So one of the things that I have encouraged people to do is just the second they get out of bed, give yourself some healthy fat. Some carbohydrate, and some salt. And that’s that fertility macaroon that I talked about that we’re featuring in Baby Making and Beyond.

And by changing nothing else, but doing that, within I think a cycle or two I was able to raise my BBT. The floor of that up a little bit. I still have low BBT. I didn’t go up to 98 degrees. And that’s ok. It was interesting to me that I was able to do that. But different people’s base body temperature is different for different reasons. So just because you hover around 97 and 97.6 doesn’t mean you have a thyroid problem or a hormone problem.

I actually did my DUTCH testing and found out that basically all of my hormones were high. Which was really interesting to me. So I’m working on that, and making sure that my liver is functioning properly to clear those hormones out. But it had nothing to do with me being low in progesterone. Which was really interesting to me, and kind of made me realize that as much as I aggressively want to believe that this one thing made sense for everybody. As usual. The truth kicks me in the pants. There’s always a spectrum of experience.

If this does have to do with hormones, Meg do you want to speak to that?

Meg Reburn: For sure. Yeah. And you know what, I just also want to speak to; I agree. I’ve seen so many people where their hormones are perfect, and their basal body temps are just low. And that’s just totally how they roll. I think people worry; maybe my metabolism is too low. But I think you're a perfect example of that. I’ve had many meals with you. You don’t have a low metabolism. {laughs} I think you have a rocking metabolism that most women would die for. And yeah. It could just be how you roll.

But, that being said. There are some other things to consider. Maybe I should just back up and just explain what a body basal temperature rise is. Just in case people aren’t familiar with that. Essentially, people that check their basal body temps check it in the morning, first thing when they wake up. They have to have three solid uninterrupted hours of sleep to get a good reading. Your temperatures are lower in the follicular phase of your cycle, and higher after you ovulate, or in the luteal phase of your cycle.

One of the ways that we confirm ovulation is by looking for a temperature rise of usually about 0.4 degrees Fahrenheit; or for Canadians like me, 0.2 degrees Celsius. Which happens the day after ovulation, and signal that your body has ovulated, it’s now producing progesterone. And we usually see that steady increase and steady rise until you have your period again, when it drops back off.

So, for women who are ovulating, they should see that rise. And for Nicole; I think her name was Nicole, right? Yeah. Nicole, she’s getting that rise. So it’s telling us that she’s quite likely ovulating. Which is a really great thing. Especially if she’s working on baby number three, I think she said. Yep, baby number three. So that’s really great.

Getting her thyroid checked is a good idea. I think it’s a good idea for anyone, particularly if people have had multiple babies. Having babies is one thing that can really throw your thyroid out of whack. Postpartum hypothyroidism is the technical term. And it’s incredibly common. More common than I think we frequently diagnose. It can happen anywhere up to six months postpartum. So if she hasn’t already had her thyroid checked since she’s had her other babies, I think that’s a really good thing.

Aside from the low basal body temperature, things to look for if your thyroid is low. I think you’ve talked about this on other episodes, but maybe we’ll just review it again. But the big ones are feeling cold. Cold hands and feet, and a real intolerance to cold. Just really not digging being cold for one hot second.

Constipation is another big one. Having dry skin, dry nails. Weight gain is a really big one, which can be tricky for postpartum women, because often times we’re just still working on baby weight that we might have gained, so that can be masked sometimes just by being postpartum. Heavy periods is another big one. So if her period has returned, which it sounds like it has. And they’re really heavy, and they have a lot of clots in them, that can be a sign of low thyroid.

And a slow heart rate. She should check her heart rate. If she’s not an endurance athlete, if her heart rate is under 55, that could indicate that her thyroid might not be functioning as well as it could. So those are all kind of things that she can do without a lab test. But going to see her primary care provider, and getting a good thyroid test would be a smart thing to do.

The other thing that can affect basal body temps are progesterone and estrogen. Which, in Baby Making and Beyond, we’re doing a lot of research on the estrogen/progesterone/thyroid connection. I think there’s a pretty common misconception that progesterone is the magical thing that makes your temperature rise. And from all of the research I’ve done, that doesn’t necessarily seem to be true. We don’t exactly know what causes the temperature to rise in the luteal phase. But it might not be exactly accurate to say that it is all about the progesterone.

Progesterone seems to have a warming quality in the body. And I don’t think it’s the actual progesterone that’s warming. I think it’s more that it is opposing the estrogen, which is cooling. Have you done some reading on that, too?

Liz Wolfe: Yeah. This is actually a discussion that you and I had.

Meg Reburn: Oh yeah, that’s right. {laughs}

Liz Wolfe: I’m like; oh yeah, we talked about this.

Meg Reburn: I get contact baby brain.

Liz Wolfe: No, 100%. And you and I have had so many discussions about this. Where we’re like; Hey, did you see this? Yeah I saw that. Let’s asks one of our researchers about it. And so and so. But yeah, this is the conversation that we had where we talked about this could just be the opposition to the cooling influence of estrogen.

Meg Reburn: And I think it is. So for this case, maybe it’s that estrogen is too high. Particularly in her early phase. And it’s affecting her temperatures by suppressing thyroid function during that time. So for her, I would say if you're going to your doctor and you're getting your blood work done for thyroid, you should ask for your estrogen and progesterone to be done as well. It’s better that it’s done around day 21 of your cycle, because then you’ll get a good gauge of how much progesterone is in your system. And you’ll be able to have a better gauge of your estrogen/progesterone ratio in your luteal phase.

She could also get her estrogen levels done on day 3 of her cycle, just to see if they’re sky high. And that might be causing her temperature of 97. She could get some functional testing done, like a DUTCH test. That might be a little bit more helpful than just a serum blood test. Because that will tell her if she has certain metabolites that might be a little bit out of whack. And there are different supplements, and different regimes you can do to work on particular metabolites of estrogens and progesterones to get those back into balance. So those are all things to consider.

Liz Wolfe: And I know we love geeking out on stuff like that. “Maybe it’s not the progesterone’s warming; maybe it’s estrogen is cooling!” For a lot of people, this does not matter. But I think it’s important to be detail oriented. And this is how we bring a unique view. We’re not satisfied with what we think we know. We have to dig a little bit deeper.

Meg Reburn: And I think knowing the why is just fascinating, personally.

Liz Wolfe: Me to.

Meg Reburn: I think knowing the why can help you really pinpoint. It’s a time saving measure. If you know why, and you can figure out; “My estrogen is off, and it’s this metabolite.” Then you don’t have to waste a bunch of time and money trying to figure out how to put things back into balance and just grasping at straws. You can just try to work on that one particular thing. You’ll probably see that things happen a lot quicker for you.

But if she’s also been doing her basal body temps, and she got pregnant with basal body temps at 97 to 97.6, then it might just be how you roll. And you might not have to do anything.

7. A journey of balance versus healing [37:10]

Liz Wolfe: Yeah. And that was me. It’s really interesting; one of our BMB researchers, Amanda, is very pro-acupuncture, and pro-Chinese medicine. Which I think is so cool. She’s a neuroscientist. She’s totally brilliant. And there’s a ton of literature supporting these types of approaches for almost anything. So much so that a lot of university medical systems and research hospitals are starting to actually incorporate those modalities into their medical practices. Which I think is fascinating.

But one of the coolest things; there’s this acupuncturist in Kansas City. Her name is Mary Jong. I know people in Kansas City are going to want to know her name. I have several friends that have gone to her. She’s very; don’t expect a spa experience when you go to see her. {laughs} It’s very straightforward. But she’s lovely, and she really cares about her patients. She’s just lovely in her own very business-like way. She’s got a lot going on, and a lot of people to see.

But one of the really cool things about her is that she just has an intuition that is just legendary in the city. And several of my friends, including one I spoke to the other day, basically were like. One of them was like, “I just found an MD. This amazing MD who told me that I was dealing with this, this, and this. And Mary told me that by looking at my tongue.” {laughs}

Meg Reburn: {laughs}

Liz Wolfe: And I was like; are you serious? And the thing about Mary is she can pinpoint. She just knows. And that’s always been really interesting to me. And one of the things that for a long time I’ve been thinking, “There’s no way my hormones are ok. My basal body temperature is always so low. This just doesn’t make any sense to me.” And I’ve been trying to assign myself a problem. And I’m finally coming around to the fact that, shrug. This is just how some people are and I’m ok.

When I went to Mary, she was like, “Oh, you're fertile. You're just fine.” Who knows, we haven’t tried to have another baby again. But it was very interesting to me that not only were all the signs; the fact that I was able to get pregnant in the first place. And that I cycle regularly. And all of these things. And my hormones are, probably too high, but I’ve got hormones flowing through my system. And Mary also told me I was fine.

But I was trying to assign myself this problem for the longest time. And I think the fact is, just because you have whatever it is, doesn’t mean that there’s a problem. And I have no idea why I had to bring Mary Jong into that conversation. {laughs}

Meg Reburn: {laughs}

Liz Wolfe: Just this idea of being able to predict something with other signs. It’s not always just about that one thing.

Meg Reburn: I think you might even be doing it again. {laughs} I’m just going to call you out on it. Because maybe it’s not that all your hormones are too high. On the spectrum of everybody’s hormones, it’s like a bell curve. There are going to be people that are on the low end. There are going to be people that are on the high end. And then there are going to be a lot of people in the middle. Maybe you're just on the high end of normal, and there’s nothing wrong.

And you know I think; as much as we love nerding out about these things, sometimes the nerding out about these things can create anxiety and create problems that don’t actually exist. And make us think there’s something wrong with us. When actually, there’s a lot of things right with us. And I think when we’re thinking about having a baby. And we’re pregnant, we want to do all the things right. So this is the time in our lives as women where we tend to get super geeky. We just want to know all of the little details. And sometimes the little details can totally get over our heads.

I think you and I talked a little bit about the concept of healing our bodies versus balancing our bodies. We’re really trying to stay away from the word heal in the Baby Making and Beyond space. Because often times, it’s not that there’s something wrong with us and we have to heal a wound. It’s that things are just a little bit out of balance. It’s like a little bit of an indicator that we just have to change something in our lifestyle to create more balance and more space for our bodies to just do what they need to do naturally.

Liz Wolfe: Yeah. I think the discussion we had is balance is just this ongoing process of observing and adjusting where you can. Where as healing feels like; A) either something wrong that you need to fix, and B) it implies this destination. Once you get to this point, then you’ll be healed and you’ll be ok. And I think that’s just a false construct. I don’t think that exists. I think it’s that process.

Meg Reburn: Totally. It’s all about; there is no destination. I totally agree. It’s like, if you take a piece of wood and you put it on a bottle. And you're balancing on that piece of wood. One leg goes one way, the other leg goes the other way. You're totally balancing. One time the left leg might be higher than the right leg, and then the right leg might be higher than the left leg. It’s just about doing this intricate dance with your health and your entire life that you need to think about. Rather than, I’m broken and I need to fix myself with XYZ.

Liz Wolfe: It’s like stand up paddle boarding, right?

Meg Reburn: That’s what I’m; yeah, that’s a better analogy.

Liz Wolfe: It can feel really effortless once you’ve kind of found your groove. And maybe that’s a little bit different for everybody. And then you kind of know when things are getting out of balance. {laughs} I really do want a stand up paddle board, Meg.

Meg Reburn: I do too. {laughs} That would be nice.

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8. Turning a breech baby [43:29]

Liz Wolfe: Let’s do a couple more. Let’s see what we’ve got time for. Ok. “I’m 33 weeks pregnant with baby two, and almost had an emergency C-section with my first. This time, baby boy is not only measuring big, but is breech. My midwife has been giving great suggestions on trying to getting the baby turned. I do not want a C-section, however I need to prepare myself in case we have to. My question is; how would you not only mentally, but physically prepare for a C-section? Any recommendations on recovery? I’m actually more concerned with recovery, especially with a 1-year-old.”

We had somebody second this one. Just saying, “I’m 38 weeks, and baby has been breech since 35.”

They want to know; of course, we always say spinning babies. If you don’t know about spinning babies already, look at spinning babies. But other than that, what are your comments on this, Meg?

Meg Reburn: So spinning babies is a really great resource. I think most practitioners know about that website now. So if anyone hasn’t checked that out and has a breech baby, that’s definitely something to check out. It basically uses some positional things to help turn a baby.

One thing that’s worked for a lot of my clients is swimming. So swimming in the water and letting your belly hang, and just letting all of those abdominal muscles be lax. If your baby is thinking about making a turn, that will create space to let your baby turn.

The other one that I’m searching for a little bit more concrete evidence on is moxibustion and acupuncture. I’ve actually witnessed babies turn. I’ve watched them turn in their bellies when mom’s have been using moxibustion. Which is absolutely fascinating to me. And the first time, I thought it was a fluke. And then I saw it three times. And I thought; ok, that’s not a fluke. There’s something going on there.

So, moxibustion is essentially; most of the time it’s two sticks of mugwort. So it’s Chinese medicine herbs that are burned. There’s a bit of a smoke emitted from the mugwort. They’re burned, and they’re placed close to the baby toes. Moms are usually in a bit of a reclined position, or bum up in the air to help get the baby out of the pelvis if the baby is a little bit further down. Especially if she’s 38 weeks, she would want to have her bum a little bit higher in the air.

We don’t really know why it works. I wish I could say I knew why, but it seems to have some effect. If she has questions about moxibustion, she can just go and ask any Chinese medicine practitioner. They should be able to supply her with the moxibustion sticks and show her how to use them. Acupuncture also has been shown to be effective. So seeing a good acupuncturist is a good thing to do.

And then the other thing, I don’t think most midwives will do this in the states. She could be referred to a physician for this. Is external cephalic version. It’s also called ECV, and it’s done by a qualified practitioner. Under the guidance of ultrasound. And that’s when we actually would manually rotate a baby with our hands to get the baby into head down position, and facilitate a head down vaginal birth that way. And that’s something she should probably talk to her midwife about, as well.

For women who are having one of those ECVs done, there are a couple of tips about how you can cope with it. Most women if they’ve had babies before, the success rates are much higher. So it sounds like she’s had babies before. Or at least one of these ladies has. I would encourage her to give that a go.

But the big thing is ECVs have to be stopped because they’re incredibly uncomfortable. Some women explain them as painful, some women just say it’s uncomfortable. But I encourage women to bring some headphones. If they have a meditation practice that they’ve been doing. Or have any guided meditations they can put on their phone and take into the hospital with them when they have the procedure done, that can be really helpful. Just to help them stay relaxed. That’s the big thing. You have to keep your body relaxed while you do it.

9. Recovering from a C-section [47:38]

Meg Reburn: That would be it, in terms of flipping a baby. I think there were some questions about how to prepare for a C-section too.

Liz Wolfe: Yeah, and recovery. From the C-section.

Meg Reburn: So, preparing for a C-section. I think it’s something that even the brightest optimist; I think all women should be informed about C-sections regardless of whether it’s planned or not. It’s important to know all of the potential outcomes, and really inform yourself on what could happen if that’s the case.

So if you have a midwife, and you're planning a homebirth, it’s important to ask what the transportation plan is like. What it will be like when they get to the hospital. What the procedures are when you go into the operating room. When dads are invited into the operating room. Can you bring cameras, and can you video tape. In most hospitals, you can now. What will happen to the baby when the baby is born? Again, in most hospitals, babies are given directly to moms and dads. You can usually be skin to skin with baby right in the OR while they’re finishing the procedure.

Asking about what the hospital’s policies are on breastfeeding in the recovery room. Again, most hospitals these days are really good about that, and are allowing dads to be in recovery rooms and allowing breastfeeding to happen in the recovery room, too. But it’s good to just confirm those things and ask questions and be curious.

In terms of recovery, it takes a good four to six weeks for your body to fully recovery. In the first few days, you’ll likely be in the hospital. And it’s important to get up and move around a little bit. This reduces the risk of blood clots, which you're at higher risk for once you’ve had a C-section.

It’s also important to stay on top of pain control. A lot of women who really just don’t want to take any pain medication, which is quite common with the midwifery clients that we see. They just don’t want to take anything. I encourage those women, in the first few days, to just take the drugs. {laughs} And when I say take the drugs; it’s usually a combination of Tylenol and ibuprofen that will create a good amount of pain control. These aren’t heavy duty, narcotic drugs. These are over the counter pain medications. They are completely safe for breastfeeding.

If you can stay on top of the pain by taking them regularly, rather than waiting for the pain to hit, once you wait for that pain to hit, it’s so much harder to get it back under control. So certainly in the first few days, just take the pain medications on a regular schedule. Your nurse will give it to you in the hospital. That will help you feel a whole lot better. So that by day four and five, once you're out of the hospital and you don’t have help from the nurses and everyone else around you, and you're back at home. Particularly if you have another little person. Your pain will be a lot less, and you’ll be able to cope a lot better.

When you get home, really limiting lifting. Lifting should be limited to the weight of your baby. And limiting stairs. If you live in a house with multiple floors, just kind of plant yourself on one floor for the day, and have your household kind of rotate around you for the first few weeks.

In terms of diet; vitamin C, protein, and a diet lower in sugar seems to be really helpful for most women. So kind of an anti-inflammatory diet. Making sure you're getting lots of colorful veggies, which will make sure you get lots of those good micronutrients that you’ll need to heal.

Some women swear by collagen and bone broth in the first little while. And I find that kind of interesting that people seem to really do well on that. And if you look at Chinese medicine; I’ve had a bunch of Chinese clients where the mothers will come after baby is born. And they’ll start making these soups. And the soups are usually made out of chicken feet. And when they cool, they are just gelatinous. They are so rich in collagen. The bone broth people would just die over.

And these soups, the ideal in the Chinese medicine world is that you want to keep the heat in, and you want a warm diet to help reduce any excess strain on digestion. Keep the heat in to help your body. I guess, part of the philosophy, and I’m totally probably getting this wrong. But this is what I understood from these mamas. You don’t want to let cool in, you want to keep heat in. And if you let cool in, it can affect basically the flow of energy in the body. So you want to keep the warm in.

You want to include lots of fats in your diet. So chia seeds are a really good form of fat, because they also have a lot of fiber in them, which will help your bowels move. Which is often a problem after you have a c-section. So making a chia pudding is a good thing.

Some women swear by belly bands, or binding your belly. Have you heard of this?

Liz Wolfe: I have. I did not do any of that myself.

Meg Reburn: Some women find it really helpful. And I find that it has ebbed and flowed over the years. But that’s something that you can look into if you have a C-section that’s planned. You could look into binding your belly.

And finally, I think creating space to talk about your feelings. And maybe journaling a little bit can be really helpful. Most women are planning for a vaginal birth, and having a C-section can come with a lot of feelings of disappointment, sadness, grief, and loss. And creating space to talk about those things, and not feeling bad about them is an important thing. Really important thing.

Liz Wolfe: So my thoughts on this one. And I can’t remember if you said this already. But if you're preparing for a C-section, I think it would be good to ask. First Google, and then ask your provider about; some places are called gentle C-sections, and some they’re called family centered C-sections. Where they have the option of a clear drape, where you're able to hold the baby while you're getting stitched up. There are some that will do delayed cord clamping and stuff like that.

I also want to say; whatever happens, it’s going to be ok. I think that in the holistic community, we are very anti-C-section. And I understand that. But I also want to kind of swing the pendulum back in the other direction. That is to say; one of the things that people talk about a lot in the holistic community is; “C-sections carry risks.” And yes, they absolutely do. Any surgery carries risks. If you don’t have to have surgery, it’s good to try not to have surgery {laughs} if you don’t gotta.

But the other thing to remember is C-sections are procedures that are performed all day every day. Clinicians have incredible amounts of experience. It’s one of those; it’s not experimental surgery. It’s one of those procedures that you’ve got a good team in place. It’s something that your provider probably is very versed in doing. So I don’t want people to go into these scenarios with fear about these increased risks to C-sections. Just remember, any surgery carries risks. That doesn’t mean there’s something especially horrid about C-sections.

Meg Reburn: I agree. And if you look at statistically; depending on what community you're in. But 18-25, in some communities 30% of babies are born by C-section. That’s a lot of babies. And that’s a lot of C-sections. And while we’re all working in the health care community to decrease those numbers, it is a really common surgery. And it’s not that big of a deal. And while it might feel like a big deal if that’s not what you had planned on. In terms of the actual medical piece of it, it’s not that big of a deal. And your body will heal from it really, really well. And you’ll be back to your old self in no time.

Liz Wolfe: And we’ll talk in Baby Making and Beyond about; I don’t know if we’ll put it this way in the actual program. But the different tiers of things to look out for. Right? You can look out for… Actually, here’s one thing I will throw out there recovery-wise. I think sometimes C-section moms, depending on the reason for the C-section and what stage of labor they were in when they had the C-section.

And by the way, guys. I’m a C-section mom. I didn’t want one, and I had one, and it took me like three and a half years to come to terms with it. And I feel like one of the things I’m doing with that experience is hopefully helping us have a more balanced conversation about this. Because I think in our community, it swings wildly in the other direction. Where we’re so terrified of it, and all of those supposed consequences from it, that we just cause ourselves undue stress because of it. So just a little aside there.

One of the things I think practitioners miss out on counseling C-section moms about is pelvic floor recovery. Because baby didn’t come out that way, so we assume that we’re not going to have any problems with our pelvic floor. But as you recover, kind of keeping an eye on your pelvic floor health. Your continence, and things like that. I think it is important looking at your abdominal function. Diastasis recti. Programs like Mutu, and the work that Lauren Ohayon is doing around that are really valuable for both vaginal delivery mamas and C-section mamas. I think that’s really useful.

Just one of the things I have found is really helpful is expressive writing. You can go back to the episode I did with Dr. David Hanscom. Or you can just go to BackinControl.com to learn what expressive writing is. There’s a very specific thing you have to do at the end {laughs}. I guess it’s part of what makes it work so well. But that’s been one of my major tools that I’ve used in the last couple of years.

So just remember; it really is going to be ok. I think it’s a good idea to start out with a probiotic for your newborn after that. Because one of the assumptions we have is that baby misses out on some colonization of the gut that happens in the trip down the vaginal canal. However, I don’t know how you feel about this, Meg, but I’m just not sure that all of the hysteria about that is warranted. We have babies born in the caul, right, and we don’t worry about their colonization.

Meg Reburn: Exactly! And you know what, we colonize our baby’s bacteria through so many other ways. We colonize their bacteria when they’re skin to skin with us. A lot of the bacteria on the skin that’s on mom and dad. We colonize our baby’s bacteria by giving them the colostrum that’s in our breasts right when our babies are born. And even if you're choosing not to breastfeed, you can hand express that colostrum and give that baby the colostrum by cup or by spoon or just by your finger, too.

So yeah. I think the hysteria of a few years ago was just that. I think it was a little bit of hysteria. I think it is an important thing to keep in mind. But it’s not the be all and end all. And it shouldn’t be the place where mother guilt starts.

Liz Wolfe: Absolutely. We’re going to have plenty of that for the next 18 to 26 years.

10. When baby measures “big” [59:23]

Meg Reburn: Exactly. There was another little piece in that question that I think she had mentioned; her baby boy is measuring big. That is a thing that I feel like I need a soap box. But I hate it when ultrasound techs or practitioners say that women babies are measuring large. Healthy women. So if you have tested negative for gestational diabetes, and there is no pathology that is creating a larger baby that could potentially be unwell. If your baby is just measuring large on this scale, right. It’s back to the bell curve. There are bigger babies, and there are smaller babies, and there’s a lot of babies in between.

When a practitioner tells a mom that their baby is measuring large. Or their baby’s head is measuring large. That’s one that I see really often. “Oh, your baby’s head is in the 99th percentile.” It just puts so much mistrust and fear into women, that doesn’t need to be there. So if you are told that your baby is measuring large, however you have a healthy baby. Please, please, please. Don’t worry. We grow babies that we can most often fit out of our bodies. And certainly if you're told that your baby has a large head; remember, that those baby’s heads change shape when you go into labor, and that is a miraculous thing.

Your baby’s head will not be the size that it is when it’s just sitting floating around in your belly. Particularly if it’s breech. Head shape is very different in a breech baby than it is with a baby that is head down. So if your baby turns, the head shape will change. I promise you. It will change. So please, don’t freak out about having a larger than normal baby. That’s my rant.

Liz Wolfe: Alright guys, stay tuned for part two in a couple of weeks. As a reminder, everyone can visit Meg at www.MegReburn.com. You can sign up for notifications about Baby Making and Beyond at BabyMakingandBeyond.com. That’s it for this week. You can find me, Liz, at http://realfoodliz.com/. Join my email lists for free goodies and updates that you don’t find anywhere else on our website or on the podcast. While you’re on the internet, leave us an iTunes review. See you next week.