My Second Pregnancy, Birth, and Postpartum Journey: Part 1 of 2

​Planning and Preparing for My Second Pregnancy
As a commercial fisherman’s wife whose husband is gone April through September, I have to plan my pregnancies. There really is only a very short window of time to conceive. Once we finally decided that we did indeed want a second child, we opened up January, February, and March 2022 as potential conception months. If we didn't get pregnant during that three month window we decided we would only have one child. But alas, luck was on our side and we got pregnant in February, honestly the perfect month. That gave us a due date of November 13th, neither too close to Dane’s homecoming in October nor right in the midst of the holidays. A November baby would allow us to have plenty of time together as a new family of four before my husband would have to leave again. 
 
My pregnancy spacing of three years was very intentional. I wanted to fully recover my nutrient stores after a 22 month breastfeeding journey with my first kiddo and regain full strength in my pelvic floor. Plus, I thought having a more independent preschooler would hopefully make the solo parenting of two kids a tad easier?? Luckily as a dietitian I have access to tools to easily assess my nutrition status including a comprehensive micronutrient test through Vibrant America and a hair tissue mineral analysis through Trace Elements Lab. Furthermore, I check some maintenance labs 1-2x per year just to make sure everything is on point. I offer all this testing to clients of Happy Belly as well. 

​Lab Testing & Wellness Support
Prior to getting pregnant I had already been working on addressing nutrient deficiencies (zinc, K2, and coQ10, as well as other nutrients that were in suboptimal range) that I had tested a year prior via diet and supplementation. Then in January 2022 I ordered a hair tissue mineral analysis (HTMA) test to check my mineral status and my nervous system state. The results highlighted that I was low in my macrominerals magnesium, calcium, potassium, and sodium, and that I needed to really focus on managing my stress. Based on the results I started back up on my magnesium supplement and became very intentional about my dietary calcium, sodium, and potassium sources to ensure I met my needs. Both of these tests are great tools to complete at any time in your preconception journey. 
 
At the beginning of my first trimester I also ordered my own personal blood labs including full thyroid and iron panels, CBC, CMP, vitamin A, vitamin D, vitamin B12, folate, RBC magnesium, copper, ceruloplasmin, and zinc. The results highlighted suboptimal vitamin A, magnesium, and zinc levels. With the above blood lab results along with my HTMA results I was able to implement my own unique food and supplement routine. 
 
Along with addressing my nutrient status and stress levels, I went to see Dr. JoAnne at Rooted in Wellness Chiropractic. She uses more tonal chiropractic techniques along with diagnostic tools to test your sites of muscle tension and your current nervous system state. With her adjustments and my individualized nutrition support I was able to recalibrate my nervous system to be the best she has seen. I continued to see her throughout my entire pregnancy to support my alignment and overall wellness. I highly recommend that anyone local to Bellingham reach out to her as well!

​Pregnancy Journey
Otherwise, my second pregnancy was very similar to my first. No complications and no real complaints. I also gained similar amounts of weight with each, about 25-30lbs. During my first trimester I did experience some mild nausea and fatigue during weeks 6-8, but that cleared up pretty quick. Eating balanced meals, with a big focus on protein rich foods, really helped keep my blood sugars stable and my nausea and fatigue within control. I also had some mild constipation, but I knew how to keep things moving. In addition to a whole foods diet rich in fiber, I focused on drinking plenty of coconut water and enjoyed a variety of papaya, kiwi, chia seeds, and Nancy’s Probiotic yogurt daily. 
 
The second trimester went by really fast, it was summer after all. I intentionally reduced my client load, and tried to find more “quiet solo time” usually as a nature walk. Throughout my entire pregnancy I made sure to walk every day if possible. My daily goal was 3 miles. Sometimes it was more, sometimes it was less. And sometimes, I didn't get any “real” movement in, and that was okay too. I tried to give myself grace when it didn't work out like I intended. Honestly, pregnancy and postpartum are the most important times in your life to try and chill out. The harder you work, and the more you add to your list, the more you dig yourself a hole. So please, don't try to do it all. If you can take things off your list, reduce your exercise intensity if you are used to pushing yourself hard, and find some time to just relax. During my mid second trimester I also repeated my blood labs and completed another HTMA test to see what dietary and supplement adjustments I might need to make. Magnesium levels dropped a little bit (not surprisingly because pregnancy increased magnesium demand so much), so I increased my magnesium supplements again from 240mg to 360mg and took them every day religiously before bed. 
 
The third trimester was smooth sailing as well. I tested negative for gestational diabetes and Group B Strep. Woohoo! However, based on current classifications of anemia during pregnancy (hemoglobin <11g/dL), my labs at 27 weeks indicated “slight anemia” at 10.9g/dL. Currently there is much debate in the medical field around classifying anemia with a cut off of <11g/dL or <10.5g/dL. Many argue that 10.5g/dL should be the true cutoff point due to the natural hemodilution that happens in the late second trimester and early third trimester. Therefore, I declined the three IV iron infusions that were suggested by my nurse midwife and instead continued to focus on eating 2-3oz of liver per week and eating grass-fed red meat almost daily. I only supplemented with a small dose of easy to digest iron bisglycinate (28mg) occasionally when I did not eat liver or red meat, which was about 2x per week because my prenatal did not contain any iron (which is intentional). I am very cautious with iron supplementation as there are both benefits and risks to assess and personally don't agree with blindly supplementing high dose iron or IV iron infusions unless there is a true need. Generally speaking “mild” cases of anemia (hemoglobin of 10 - 10.9g/dL per WHO) respond beautifully to dietary interventions and do not need high dose iron replacement or iron infusions. Normally over the course of the third trimester hemoglobin levels rise naturally from their lowest levels around 24-30 weeks of pregnancy. So if hemoglobin levels were fine all throughout your first and second trimesters, and then dip, know that they will start increasing again at 33 weeks. If you start your pregnancy with a hemoglobin of <12g/dL you may need earlier interventions (food first, then supplementation) to avoid more moderate or severe anemias later on in pregnancy. As you can see, iron metabolism during pregnancy is much more complicated than just replacing iron. Along with normal hemodilution during the third trimester, there are other nutrients of concern, including vitamin A and copper which play an essential role in iron metabolism that unfortunately are never tested for or mentioned in the traditional health care model. Furthermore, in addition to checking vitamin A and copper, testing a full iron panel along with ferritin instead of just hemoglobin is ideal to assess true iron need. So please, work with a skilled dietitian to help guide you throughout your unique journey. And just to note, with my food focused interventions and the natural increase in hemoglobin concentration my hemoglobin levels were at 13g/dL at the time of delivery. No IV infusions needed and no harsh ferrous sulfate supplements. Yay for self-advocacy!

Birth
Since I was considered a “geriatric pregnancy” this time around, I did have more ultrasounds and weekly non-stress tests during the last four weeks of my pregnancy. Luckily the results all came back great and I was able to push back the suggested 39 week induction to the middle of my 40th week. I hoped I wouldn't need it. I hoped that the baby would come before 40 weeks just like my son Toren. But alas, my journey this time around was not the same. At 40 weeks and 4 days, I was admitted to Peace Health Child Birth Center to start my induction process. After a week of processing high and low emotions, and the wonderful support and guidance of a dear friend, I arrived at the Child Birth Center feeling very grounded, empowered, and ready. Ready to have an amazing labor. I left fear behind me, and entered with such presence. I had an amazing team ready to help me have the best experience - my nurse midwife, two awesome Labor & Delivery nurses, and of course my amazing husband. Since I was only 2cm dilated my induction process started with Cervidil – a cervix ripening prostaglandin that is inserted vaginally. My midwife said, “We will wait 4 hours, and then check how far you are at that point. If you are 3cm or more, then we can start Pitocin”. With four hours of waiting time, my nurse helped me through a Miles Circuit (to help get baby in the best position) and she massaged my hips to help release and relax my ligaments. I also got to enjoy a steaming hot bowl of delicious Pho and a side of diced papaya and lime that my husband brought me for lunch. 
 
And then it was go time. At 1pm my midwife checked me again and said, “You're at 3 cm, we can start Pitocin or do another round of Cervidil”. I asked the nurse what dose is usually required to help kickstart labor for women and she said that it ranges between 8ml/min to 20ml/min. I opted for Pitocin, and jokingly said “Hopefully I will only need a little Pitocin Kiss to get going”. With Pitocin they generally start at 2ml/min and increase by 2ml every 30 minutes until contractions start to get intense. With the first 2ml, I noticed gentle contractions. By 4ml/min I had to do some breathing through them, and by 6ml/min I was groaning through my contractions and moaning my mantras “Opening”, “Releasing”, and “Sensation”. When the nurse came in to check in on me at 4:30pm my water broke. It felt like a water balloon had popped inside me. Then things got really intense fast. They started to titrate the Pitocin back down again, and eventually weaned me off. So indeed all I needed was a little “Pitocin Kiss” to get my body to do its own thing. At 5pm they checked me and I was at 5cm. With the support of my amazing husband I continued to labor another hour with my mantras and deep groans and relaxed in between contractions with deep breathing, cold wash cloths, and the loving touch of my husband. At 6pm I hit transition, the intense contractions that leave you shaken to your core. I was checked again and I was at 9.5cm. “You’re ready to start pushing!” said my midwife. And so I did, surrounded by my amazing support team. 
 
After 20 minutes, my husband caught our 8lb 2oz baby and announced that it was a girl – the most amazing blessing I could have ever asked for! My little golden girl Aspen finally made her debut. She immediately came to my chest, latched to my breast right away, and the cord clamping was delayed at least 5 minutes if not longer (time has no meaning so it’s hard to know exactly). I was so in love, so blissed out, and so extremely happy. I did it! I was 200% there mentally, emotionally, and physically…and for an extra bonus I didn't even tear. Phew!
 
Although I was much more present with myself this time around, I felt much more disconnected with this pregnancy. I have talked to many mamas and most agree they felt the same. Life is much busier when you have another kiddo in tow while you are working and pregnant. It’s also not your first rodeo. The “new” excitement isn’t there. You have been there done that already. I also struggled with an intense worry that I wouldn't be able to love my second child as much as I loved my first. But trust me….this is NOT something you need to lose brain cells on. Aspen has shown me that your heart can grow twice as big to allow for so much more love than you could have ever imagined. And now as a family of four we navigate the change of pace and adjust to the ebbs and flows of this wonderful journey. 

My Second Pregnancy Tools, Diet, and Supplements: 
IMPORTANT DISCLAIMER: This is not medical advice. This is what I did based on my unique needs. Please talk to your health care professional and/or dietitian to see what is right for you.

• Hair Tissue Mineral Analysis Test by Trace Elements
  1. Preconception and Mid 2nd Trimester
• Blood lab analysis (done early 1st trimester) - not typically done in the traditional care model
  1. Full iron panel with ferritin
  2. Full thyroid panel with antibodies
  3. Vitamin A (retinol), vitamin D, Vitamin B12, Folate, Serum copper, Ceruloplasmin, Plasma Zinc, RBC Magnesium, Omega-3 Index
  4. CBC and CMP – usually done in traditional care model but I like to assess it along with the above. 
  5. Repeat labs as necessary
• Health Care Providers:
  1. Rooted in Wellness Chiropractic: Started in mid 1st trimester – throughout pregnancy and into postpartum.
  2. Peace Health Nurse Midwives: A great middle ground between going to a birth center and traditional OBGYN care. Since I had a more complicated birth story with my son Toren, I opted to deliver in the hospital from the start. 
• Diet: Nutrient Dense Organic Whole Foods Diet 
  1. Real Foods for Pregnancy by Lily Nichols – great resource
  2. Ate out rarely – maybe 1-2x per month
  3. Most meals cooked at home from scratch
  4. Aimed for ~30g of protein per meal, with a daily goal of around 100g of protein. 
  5. Ate a variety of plant foods daily with a big focus on potassium.
  6. Seasoned my foods to taste with salt – I like my salt!
  7. Hydrated with plenty of filtered water and used Trace Minerals. 
  8. Honored my cravings and my hunger – even if it was in the middle of the night.
  9. Avoided BPA exposure whenever possible: no plastic containers or bottles, declined receipts, purchased BPA free canned beans like Eden’s.
  10. Avoided high mercury seafood and raw oysters, as well as any pre-made deli foods like salads, wraps, sandwiches, etc. Otherwise I ate everything else if it was quality fresh food. This means I chose to eat poke from an establishment that I trust, runny egg yolks, quality deli meat for homemade sandwiches, a variety of cheeses, and liver. 
  11. Limited my caffeine intake to 1 cup of half calf coffee in the morning WITH breakfast, not on an empty stomach. 
  12. Avoided alcohol. 
• Specific Foods I Incorporated: Frequency based on my needs
  1. Grass-fed liver: 4x per month
  2. Pasture raised eggs: 2 eggs per day most days – kept most yolks runny for nutrient quality
  3. Grass-fed red meat: 3x per week
  4. Wild caught fish: 2x per week
  5. Canned smoked oysters: 2-4x per month
  6. Organic grass-fed milk, yogurt, and/or cheese: Daily
  7. Homemade bone broth: used when I made soups
  8. Adrenal Cocktails/Coconut Water: Daily
  9. Fresh Fruit: A variety every day
  10. Veggies: A variety every day
  11. Beans/Legumes: Few times per week
  12. Whole Grains: Daily
  13. Nuts/Seeds: Most days of the week.
  14. Fermented Foods: Almost daily
  15. Seaweed: Few times per week mostly in my bone broth, as seaweed snacks, or as dulse granules. 
• Supplements: Product & dosing adjusted to my specific needs
  1. Seeking Health Prenatal: Throughout – ½ dose
  2. Grass-fed Collagen: 1 scoop daily in my half calf coffee
  3. Magnesium Glycinate: Throughout – 360mg
  4. Nordic Naturals Fish Oil: Throughout - 1-2x per week, as needed based on dietary intake
  5. Trace Mineral Drops: Throughout - as needed in my water 
  6. Choline: Throughout – 500mg 2-3x per week when I didn't eat eggs for breakfast
  7. Jarrow Formulas Femdophilus: 2nd – 3rd trimester, 10 billion to start, then reduced to 5 billion as maintenance - for Group B Strep prevention.
  8. Iron Bisglycinate: 3rd trimester, 28mg ~2x per week based on my lab work
  9. Melatonin Drops: Micro-dosed at 0.5-1mg as needed for sleep support
  10. Nourished Nerves Calming Tonic: as needed for sleep support
  11. Calm Tummy Bitters: as needed for indigestion
• Exercise: 
  1. Walking outside: +/- 3 miles most days
  2. Swimming in the summer
  3. Sunshine on my skin and belly for at least 10-15 minutes every day during the Summer months.
  4. Gentle resistance training: 1-2nd trimester 1-2x per week.
     1. MadFit
     2. ​Fitness Blender

1. For Labor & Delivery:
   1. Birth Hour Podcast – listened to this almost daily during my third trimester while out on a nature walk. 
   2. Birth Affirmation Mantra Cards – I picked out my favorite 3 to use throughout my labor. 
   3. Bridget Teyler – Visualizing your Positive Birth
   4. Miles Circuit – helps get the baby in the right position.
   5. Spectra Breast Pump – used it in the days after my due date to help stimulate labor.
   6. Foods during Labor: easy to digest Pho bone broth noodle soup and freshly diced papaya with lime. 

Stay tuned for my postpartum update!