Navigating Weight Gain in Pregnancy: Expert Advice with Midwife Insights
The information provided on this podcast is for general information purposes only and is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your qualified health provider with any questions you may have. Never disregard professional medical advice or delay in seeking it because of something you have heard on this podcast. Reliance on any information provided here is solely at your own risk. This episode is sponsored by Tree of Life Breast Milk Jewelry.
Ciarra:Tree of Life Breast Milk Jewelry creates keepsakes that will last a lifetime. Using breast milk, placenta, umbilical cord, and more, Free of Life breast milk jewelry has customizable pieces that can include your child's birthstone and can be engraved. Use code podcast at checkout for 10% off your first purchase.
Samantha:Welcome. This is birth, baby. Your hosts are Ciarra Morgan and Samantha Kelly. Ciarra is a birth doula, hypnobirthing educator, and pediatric sleep consultant. Samantha is a birth doula, childbirth educator, and lactation counselor.
Samantha:Join us
Ciarra:as we guide you through your options for your pregnancy, birth, and postpartum journey. Hey, everyone. Today, we have Leonora back with us from Homebirth Honey here in Austin, Texas, and she is here to talk with us today about weight gain in pregnancy, which is something we get asked about a lot. So thank you for being here again.
Leonora:Absolutely. It's my pleasure.
Samantha:Excited to chat with you about this. I think I say that at the beginning of every episode. That's just how I start my episodes. I am excited. We are
Leonora:excited am. I am excited about this episode because it's just something I've been wanting to talk to lots of people about. So this feels like a great platform for that.
Ciarra:Yeah. I love that this one was your idea. Yeah. You were like, hey, guys. I wanna talk about it.
Ciarra:And we're like, well, then we should do that.
Samantha:Bring it on. Yeah. I love it. I I mean, it's such a big topic on on, like, every side of it. Like, how much weight is too much weight?
Samantha:How little weight is too little weight. I know when I was pregnant with my second, I was super, super sick and I lost so much weight, that I just I was so worried about her because I was so skinny and so sick all the time. And you were one of my midwives at that time, and you were very helpful in helping me figure that out. You're, like, just eat butter on everything that you ever eat, and that helped actually.
Leonora:I literally have a butter tattoo. I want it so much.
Samantha:I still live by that rule, which maybe is not my best choice, but it's it's fine.
Ciarra:It's we just blame Leonora.
Samantha:Yeah. Exactly. So we hear a lot of thoughts and opinions on what is normal weight gain and pregnancy, from everywhere and everyone. So, you know, you're eating for 2, you, you know, you need to eat more, or you can't gain too much weight. Otherwise, you know, you're putting yourself at risk.
Samantha:It's hard to lose later, blah blah blah. So should someone expect to gain weight in pregnancy? And if so, how much would be, quote, unquote, normal?
Leonora:Yeah. So that's a great question, and it's one that I get asked a lot. You know, the the sort of reigning theory is that, you base it on body mass index. We all know that body mass index is racist. It is outdated.
Leonora:It is not a great way to really think about health in general, but it is a tool that health care providers use, basically to put people into different classifications and to help them make choices. So based on the that, you know, if you have a normal, quote, unquote, normal body mass index, the recommendation is that you gain between £2535. If you're underweight, you're gonna be gaining more like £40. And if you are overweight or obese, the recommendation is more in the 10 to 15 pound range. I don't talk about that anymore during my first prenatal visits.
Leonora:I talk a lot about nutrition, and I talk a lot about how you move your body, because I think that the overarching message that I would love to get across, doing this podcast is that we have all been brought up in varying degrees of exposure to media and social media. And I think all of us that grew up, you know, in the eighties nineties with the health food craze, with fat free foods, with dieting culture, we have a lot to unpack as women, as people, as humans, and certainly when we get pregnant, there is a lot there. And I see women who genuinely are distressed by the idea of gaining weight during their pregnancy. So I think that, you know, step 1, unpack what you, learned growing up, because so much of that was not evidence based, and was really based more on the economy, of selling food versus people's actual health status. All that to say, I love to really, really focus in on what choices you're making for your body, what feels good in your body, how it feels good to move your body.
Leonora:And, we have a scale in our office, but I would say that maybe once or twice during the pregnancy, we might ask that you hop on the scale. But I always check-in with people, during their first visit to ask them, like, is it gonna be triggering for you to get on a scale? Is that something you'd like to avoid? Sometimes people like to go backwards on the scale, and have us read the number for them. You know, I'm not big on numbers when it comes to weighing people.
Leonora:That was a really long answer for your very short
Ciarra:love that answer. And, you know, within my first, like, year and a half or so, so I was fairly new doula, I had a woman wanna interview with me, and I think she had seen me on social media. And, she lived in my area, and we were on the phone. She, like, cold called me, and she was one of her questions for me was, is it gonna bother you that I'm fat? And I immediately said, no.
Ciarra:Is it gonna bother you that I'm skinny? Because, like, in her eyes, I would be skinny. And she goes, no. I said, cool. I don't care if you're fat.
Ciarra:She's like, great. Because I really am worried about how I'm gonna be treated about being fat while I'm pregnant, and my doctor's already talking about it. And this whole pregnancy, she was so worried about that. And can you imagine what an awful feeling to hear that you're only supposed to gain 10 or £15 in pregnancy because your BMI is whatever it is? That's almost impossible.
Samantha:Yeah. Let's talk about how much a baby weighs and all of the fluid and all of the, like, natural blood.
Ciarra:To lose weight in pregnancy.
Leonora:It's I really look at it. On the idea that anybody with an elevated BMI has that because of lifestyle choices that they're making, not based on what their genetic makeup is, what their hormones are doing, how their body reacts to different foods. It's incredibly reductionist. And, I will say that, you know, I worked at a a large busy birth center for a decade, and it was it was a great experience, and I learned so much. And because that birth center was its own apparatus, and it had so many moving parts, It had to have a very specific risk assessment that it adhered to in terms of what types of clients they could take on.
Leonora:And, so part part of that was body mass index. And, so we would need to talk to people about their weight when they reached out to us. At the point that they had just found out that they were pregnant, we had to ask them questions about their weight or call them and tell them that they were not a good candidate for birthing out of hospital with us because of their weight.
Samantha:And they're afraid that they're that it's unsafe for them to birth out of the hospital at all because that place didn't accept them as a client. We have that happen with people all the time, and it's really it's a hard pill to swallow.
Ciarra:It is. Me nauseous thinking of you having to call someone and talk to them about that. Yeah.
Leonora:Yes. And aware of fat phobia and body stigmas and, you know, just sort of took it part and parcel as working there. I didn't feel good to have to have these conversations, but I was like, well, you know, it's just about safety and about health. But, you know, in in this life, I have done a lot of, self education about, like, what it actually means to live in a fat body, what it is to have an elevated body mass index, and the way that your health care providers respond to you, and the incredible stigma. I just I think it is so cool that that woman who reached out to you just put it out on the table and who was being self protective in that moment, because I know that there are so many birth workers out there that do have intense feelings about people's bodies that are based on their own feelings and not based on, you know, like, actual medical evidence that people in larger bodies have, you know, more adverse health outcomes.
Leonora:Now there are ways in which bigger bodies gestate differently and give birth differently. I'm not saying every single body is exactly the same, and it's gonna have the same pregnancy, and you should eat exactly the same. In fact, I think the more that I the longer I'm a midwife, the more my response to everything is everybody has different bodies. That's just that's just the baseline as we are For
Ciarra:every subject.
Leonora:Yes. Literally everything. Postpartum, everything. We all have different bodies. So there are different ways that I'm gonna counsel somebody in a bigger body, about, you know, like, what choices they're making and how they feel, but that does not put them in a higher risk category.
Leonora:So, you know, when we're looking at weight gain during pregnancy, I just now if somebody is struggling to keep weight on and struggling to keep food down, I mean, that that is a moment at which taking weights can be helpful because, you know, if you are losing a ton of weight, that's a metric that we can can keep track of that.
Samantha:But I've since done with something larger too.
Leonora:Yeah. Absolutely. I'll say, though, that the longer that I do this, the more I just feel that asking people specific questions about, like, what they're doing, how they're feeling, how certain things are making them feel, and just, like, troubleshooting the minutia of it is much more helpful than focusing on a number on a scale.
Ciarra:Yeah. We often have families who some of them switch from OB care over to midwifery care. And one of their first comments about their first appointment was always like, wow. They asked me, like, real questions about my specific situation. Like, that was really cool.
Ciarra:You know? I had one dad recently go, they finally just gave my wife what she's been wanting for all three of her pregnancies. She finally got it with midwifery care. So I think that, you know, of course, the weight gain, the numbers, all of that, people wanna know the numbers. But, really, is there, like, a too much or too little?
Ciarra:So can not gaining enough weight have a negative impact if you are somebody who's sitting there counting calories and has a really big issue with gaining weight? You don't want to gain weight.
Leonora:Yeah. That's that's a bit more of what I see these days. You know, I think I think back in the day, it was more of that, like, raining idea of, like, eating for 2. And, you know, you have to, like, kind of remind people that the person that they're eating for is, like, the size of a lentil and then, like, the size of, you know, a lime or something.
Samantha:A really hungry lentil.
Leonora:Yeah. Exactly. Yes. You you do need to to support that gestation, but it's not a ton of extra calories. But now people are, really, really conscientious about that.
Leonora:And so, you know, a lot of times if you ask somebody, you know, how are you eating? They'll be, like, great. Now I'm getting tons of protein. And then you you check-in and you you ask, okay. Like, you know, you didn't you didn't feel like you wanted to do the the diet recall that we offer at the first visit.
Leonora:So why don't you just give me, like, an average day breakfast, lunch, dinner? And they're like, well, you know, I, I make some eggs for the kids, and I probably eat, like, one egg off of their plate in the morning. And then, you know, sometimes I skip lunch, and then I always have dinner. And, you know, dinner's like meat and veggies and a carb, and I'm like, okay. You just described, like, maybe 600 calories.
Leonora:So we need to we need to do a full breakfast. We need to talk about snacks. We need to talk about how to keep your body, you know, feeling well during your pregnancy. It's just everybody eats so differently, and the way that you eat is so personal and for some people, like, quite emotional, and then also cultural. You know?
Leonora:We all have, like, culturally different ways that we eat. So part of your job as a midwife or, you know, anybody who's gonna be helping people make health choices is to make sure that you're aware of those differences and that you can speak to that, but also be able to, like, do the math and do the work to dig in when somebody says, yeah. I'm eating great. Be like, you know, how often do you eat dessert? And they're like, well, you know, only a few times a week, but, like, you know, I have, like, a bowl of Froot Loops in the morning and a bowl of Froot Loops before bed.
Samantha:You know, you can kind of Mhmm.
Leonora:Out these things that that they find to be really normal, but that you're like, oh, that's that's not actually gonna serve you, during this pregnancy as much as you think it will.
Samantha:Yeah. I think that's I, like, I just remember how I felt when I was as thin as I was in that pregnancy, and I was just tired. It was it was hard because I was I didn't have enough my body was not getting enough fuel to fuel me through my life with a 2 year old and a pregnancy and everything else that I was doing. So I knew that I needed more, and that's why it was helpful to have that care of, okay. Well, what can we do?
Samantha:Like, what little things can we add in to help get you where you need to be? And, really, that's what it comes back to. Like, you know, we we talked about this in in our pre Zoom, meeting a couple weeks ago. Like, baby's gonna take what baby needs, but you are gonna be the one to suffer for it.
Leonora:Yeah. This is a big, idea, I think, that people have about pregnancy and about breastfeeding that, like, your intake is going to have a a huge, huge effect on baby's growth. And if you become truly malnourished or dehydrated, yes, absolutely, that will affect your baby. But if you are just chronically underfeeding yourself in a way that is, you know, more or less sustainable but not ideal, your baby will develop normally, and you will feel like absolute crap. They are we say perfect parasites.
Leonora:You know? They're they're just really good at sucking the life out of your bones while while they're in there and and when you're breastfeeding. So, you know, of course, sometimes it's helpful to explain to people that, like, yes. This is also supporting your baby because they won't do it for themselves, but they'll do it for baby. But, but it's it's so much about the mom and and about her well-being and, like, emotional well-being.
Leonora:You know? When we're underfed, emotionally, we do not feel well. We need that glucose for our brain to run. You know?
Ciarra:Yeah. That brain fog or, like, pregnancy brain. It's like, okay. Well but are we getting enough fats? Are we getting enough, you know, bits of sugar throughout our day, you know, through food?
Ciarra:I think that that is the biggest thing is that people aren't realizing, like, oh, good. Like, some people are gonna listen to this that have an unhealthy relationship with food, and they're gonna be like, The baby is gonna get what they need, and it's totally fine if I'm depleted. Like, they almost want that. And I know that that sounds awful, but, like, I've I've been somebody who has that kind of mentality before. So I get it not about the baby, but in general in life, like, I can survive.
Ciarra:And I think that the problem there is that they don't realize it all if you wanna have it come back to baby, it all still does. Because what good of a parent are you going to be able to be if you are so depleted in nutrition and you're now you're postpartum, you're having to heal after having a baby, and you're trying to produce breast milk for having a baby, and you're you're not getting as much sleep because you have a baby. And then you're also not having that nutrition, you're not gonna heal very well. Your patience is going to be thin. I think that's where people don't see that it's going to negatively affect them, and that is very true.
Leonora:Absolutely. Yeah. It's, it's that old adage, you know, put your oxygen mask on first so that you can help those around you. And I think as moms, like, that is triply true because, you know, the whole family is kind of on a fulcrum around you. And so if you are depleting yourself intentionally or unintentionally, you're gonna be functioning less ideally.
Leonora:Your family is gonna be functioning less ideally, and you're gonna be setting a template for your children to show them that it is okay for mom to come last, you know, for her to be the last person served, the last person to get free time, the last person to bed. Like, that's what they're learning from you, and that's that's not cool.
Samantha:Yeah. So is there any, like, actual, you know, issues that could come up from you not gaining enough weight, like, with mom's health status or anything?
Leonora:Yeah. Absolutely. I mean, again, I I don't focus as much on the weight. It's more just on, like, what, you know, calories in calories out. Like, what are you putting into your body?
Leonora:And if you are undernourishing yourself, not getting enough protein, not getting enough fat, not getting enough calories, you know, you're gonna be putting your pregnancy at risk for growth restriction. You're gonna be putting yourself at risk for a preterm delivery because if baby's not getting enough calories on the inside, they're gonna look to come out on the outside where they can catch up on growth. And, you know, I would say preeclampsia is something that is not completely understood, but they are starting to understand more about it. It. And I do think that, for moms that don't get enough protein in their diet, I I really do see an uptick in the likelihood of preeclampsia.
Leonora:I also think, you're less likely to be sleeping well. And then, also, your hormones are fat soluble. So you you do need some fat on your body to be able to comfortably gestate a baby and go into labor and have all of these hormonal responses that are normal during pregnancy. You know? And I actually when I was pregnant, I was talking to the the old owner of the birth center.
Leonora:She was this kinda funny old school midwife, and she was like you know, she didn't know not to talk about body. She's like, look at you. You haven't put on anyway. And I was like, have you seen my butt? Like, it's too large.
Leonora:And, she was like, oh, you know what? That's just your body storing blood. And I was like, you know what? Like, because my my thighs had gotten bigger and my butt had gotten bigger. And I was, like, that is so comforting to me to think of, like, all of that extra blood that my body was storing, because we all know that with birth there is a physiologic amount of bleeding that happens, and it can be up to 2 cups of blood that is still, you know, pretty much within the range of normal.
Leonora:So the idea that all that extra blood was just hanging out in my body, getting ready for birth, I just found that to be so comforting, personally.
Ciarra:Cracking me up because I love that that was comforting for you. And if someone told that to me, I'd be like,
Leonora:shit. My
Ciarra:wrists would stop working. I'd have to sit down. That would be so gross for me to hear that my blood was in my butt. I love that so much.
Leonora:I was just, like, slapping my hindquarters, like, yes. There it is. That's what's there. Right.
Ciarra:All that blood jiggling around back there. I like it. Oh my lord. Now what about the opposite? What about are there any health risks to gaining too much weight during pregnancy?
Leonora:So I I have had I have served moms who have lost weight during their pregnancy, you know, who maybe started out on the higher end and made some, like, big, big life changes while they were pregnant and just kinda slowly, you know, plateaued and lost a tiny bit, and that worked out for them. Again, it was based on choices that they were making, not based on the idea that they were, like, dieting during their pregnancy. And I have helped moms who have gained up to a £100 during their pregnancy. I don't think that gaining that much weight makes anybody feel particularly good in their body usually, and it's usually based on, you know, again, that idea of, like, eating for 2, kind of like forcing yourself to eat maybe a bit more than needed. Just to go over the recommendations, the recommendations in the first trimester, I believe, are an extra a 125 calories per day.
Leonora:2nd trimester, in the range of 250 calories per day. And 3rd trimester around an extra 300 calories per day. It's
Ciarra:Breastfeeding an extra 1000000 calories per day.
Leonora:Breastfeeding is an extra 500 calories per day that I would take every day in these, like, giant sugary protein bars. I was like, I need this. So, yeah, your your actual nutritional needs do not increase significantly for pregnancy. But what does increase is your need for high quality food and especially for protein. Most of us do not get enough protein in our diets.
Leonora:You know, I'm I'm entering my perimenopausal years, and I'm working with this amazing midwife named Heather Satterfield, who, is also a nurse practitioner, and she has helped me to remember, which I should know as a midwife, how stabilizing protein is for our blood sugars. So, really, you know, we ask that our moms be shooting for 80 to a 100 grams of protein a day, which when you tally it up, unless you're just going ham, pun intended, on meat, most people are not hitting that goal. So I'm not pregnant, and
Ciarra:I'm working with a functional nutritionist. And I'm sitting here trying to get more more protein, like, they're telling me to. And y'all, I'm full. I'm really having a hard time eating the foods I wanna eat because I'm sitting there trying to get the protein in first, and that is a job.
Leonora:Yep. It's hard. It's hard. And I, you know, I recognize that. I I really remember being pregnant and being like, this I do not want to eat meat and veg.
Leonora:I want froyo. Like, straight up, that was what I wanted. Mhmm. But, you know, I will say that the one thing that does not serve us during pregnancy is sugar. Sugar has a really not ideal effect on our health nonpregnant and especially when we're pregnant.
Leonora:We really need to be looking to our, metabolism to avoid gestational So So because of that, I always tell people, like, you know, really, really focus in on the protein because, just like you said, when you're getting enough protein, you're not you're not really thinking about sweets anymore. You're just really full. But also fiber. Fiber is really, really important. And, if you're eating lots of fruits and veggies, lots of whole grains, you're probably doing great with fiber, but not all of us do that.
Leonora:So you do need to be, you know, keeping an eye on fiber as well. If you're kind of focused on protein and fiber, a evening ritual of maybe some dark chocolate or a sweetened yogurt or something like that. But there is so much hidden sugar in the American diet, that if you are not cooking your own meals, you are likely having a ton of sugar added to everything that you eat. Really, one of the biggest things that you can do to help your health, in general and especially when you're pregnant, is to make your own meals. Really where we go off the rails is when we're buying premade food or food that's made at restaurants because there's just no eye to nutrition unless you're really bougie and buying from super high end places.
Leonora:They're all about the health food, which if you can afford it, kudos to you. I can't. I have to, like, make my own food mostly. But that's okay. You know, that that's a good practice.
Ciarra:And I think what's important about what you're saying too is to remember that when Leonor is saying all of these things, it's because of how this is going to make you feel, how how it's gonna make your body react. Again, not because of how much weight you are gaining. I do wanna touch on you said that like, we asked you about the gaining too much weight. The biggest thing that we have complaints from with people who gain more weight than they anticipated isn't how they look. It is how they feel and their mobility.
Ciarra:And then in labor, they're like, my thighs are giant. Like, it is so much harder to move my body right now. And they had all these things they wanted to do, and they wanted to be on all fours and whatever. And they're like, I feel like I can't even move in my own body. So Yeah.
Ciarra:Putting an emphasis on that, I think, is really important. And you said that the BMI was con like, a consideration, as a risk factor, for example, with the birth center that you worked at and things like that. Can you explain the why behind that being a risk factor? Like, what the thought process is there?
Leonora:Mhmm.
Ciarra:Did you already maybe you did. No.
Leonora:No. I didn't. The idea there actually is relates to what you were just saying. The idea is that when you're birthing out of hospital, mobility counts. We need to be able to you know, if you're in the tub and, you know, the baby's head delivers and we're trying to get those shoulders to deliver and the shoulders are maybe a little bit sticky, quote unquote, and we say, hey.
Leonora:I need you to get out of the tub right now. I need you to, step out of the tub and get over here to the bed. I need to know that the person that I'm asking to do that is going to be able to move when they are that pregnant, when they are in labor. And then the other thing, the the one thing that actually is incredibly important when it comes to that is to be able to hear fetal heart tones with a Doppler. We all have a layer of fat on our tummies.
Leonora:That's totally normal. But if that layer of fat gets too thick, the the dopplers that we use out of hospital to auscultate fetal heart tones, they don't pick up on heart tones as easily. So we do need to make sure that when we come in for those heart tone checks within reason, it's not taking us a long time to hear baby. So that's why, again, in somebody, you know, who is fat or who has an elevated body mass index, I wanna know, like, are you exercising? If so, like, what does your exercise look like?
Leonora:How are you eating? And a lot of times people will come to me, and they'll be like, I'm a weightlifter. Like, the reason that, like, my body mass index is so high is, like, I have a ton of muscle on my body. And that typically plays out that, you know, yes, they are just, like, a super solid, strong human being, who, you know, has maybe, like, bigger bone structure, and that is, you know, why they are higher on the body mass index scale. Once in a great while, I'll come across somebody who genuinely is struggling a little bit with their mobility and maybe does have that that layer of fat on their stomach that makes it hard to hear fetal heart tones.
Leonora:You know, so that that's gonna be the main issue. There is a increased risk of gestational diabetes. There is a increased risk of hypertension. But guess what? We're screening for those things.
Leonora:So Right. The risks associated with gestational diabetes decrease almost to nothing when that gestational diabetes is diagnosed and when it is treated appropriately. So if you've got gestational diabetes and that person is managing with diet and exercise and they're being followed by a maternal fetal medicine doctor and their blood sugars are staying in a nice normal range, that's a low risk delivery. We're doing those deliveries at home. If we have somebody who did not test for gestational diabetes and we have no idea, that's not as low risk because we don't know.
Leonora:That that baby might have some issues after they're born. We're checking blood pressure every time we see somebody and multiple times during labor and during the postpartum period. So if they have hypertension, guess what? We're gonna know. You know, so, yes, there there are risk factors associated there, but they're all screenable.
Leonora:Nothing is a mystery. You know, we just need to make sure that that person is gonna feel really good in their body birthing at home or in a birthing center. Just being able to move.
Samantha:And those things exist in the hospital too. People who are, you know, I guess what they would call, like, morbidly obese on, you know, the much larger side. It's harder for them to monitor baby when they're trying you know, even, like, with inductions and stuff, I I see different kinds of monitoring being necessary in those situations, like internal monitors, because they're not able to monitor externally in the same way. So it's not just something that we see at home. This happens, you externally in the same way.
Samantha:So it's not just something that we see at home. This happens, you know, everywhere, and, you know, there's there's different things to be considering and discussing with providers, you know, if that is your story.
Ciarra:Have you ever considered being a birth doula? Or are you a birth doula who doesn't feel your training taught you the things you need to know to be successful? Check out Birth Baby Academy. Our vision is to empower compassionate individuals with the knowledge, skills, and confidence to support expectant families through the transformative journey of childbirth. Through our comprehensive birth doula training program, we aspire to cultivate a community of dedicated birth companions who embrace diversity or hold dignity and provide unwavering support to birthing individuals and their families.
Ciarra:Our vision encompasses fostering a deep understanding of the physical, emotional, and psychological aspects of childbirth, enabling our graduates to offer holistic care that respects individual choices and promotes positive birth experiences. The 1st weekend training workshop will take place in Austin, Texas this September, and our self paced program will be released this fall. Check out birthbabyacademy.com to learn more.
Samantha:So I struggled in pregnancy with severe morning sickness, and that was why I struggled with my weight so much. And, you know, like I said earlier, it was really difficult for me to kind of wrap my mind around, like, is my baby gonna be okay because of all of this? I was afraid, you know, I would develop blood pressure issues and all of these different things because I knew too much. So can those things, you know, severe morning sickness or even more serious things like hyperemesis, have a role on weight and pregnancy? I mean, obviously, they do, but are those something that you're quite as concerned about as just, like, you know, diet restriction?
Leonora:So there's morning sickness, there's severe morning sickness, and then there's hyperemesis. Morning sickness is really normal. I would say most pregnant people are gonna experience, you know, at least some nausea, maybe a few bouts of vomiting. Then there's severe morning sickness where you're just you're throwing up all the time. Maybe it's not really gonna clear up by 12 weeks.
Leonora:Maybe it even lasts till 20 weeks. And then there's hyperemesis where you are vomiting uncontrollably. You maybe are going to the hospital for IV fluids. You need to take drugs to keep your foods down. Hyperemesis really takes a normal pregnancy and puts it in a different risk category.
Leonora:But if we're just talking about morning sickness, there are a lot of work arounds. You know, we always have the recommendation of eating frequently, like, even just like a handful of almonds, a cracker with cheese, an apple with cheese. You know, really small things every few hours help to keep your blood sugar steady, which are gonna help to, you know, decrease the nausea so that you're able to keep food down. But if we have somebody who is throwing up daily, who is losing weight, who is, you know, maybe keeping down 1 meal a day, maybe 2. We have medicine at our disposal now in this day and age.
Leonora:And is it completely, absolutely, 1,000,000 percent risk free? No. All drugs have side effects, you know, but the the drugs that we're able to prescribe are considered low risk enough that the benefits outweigh the risks during pregnancy. So for those moms, I find that starting them on, if possible, IV infusions and especially IV infusions with Zofran early in the pregnancy can be super helpful to get them on the right track so that it never gets really bad. Because once it gets really bad, it's almost like a negative feedback loop, and it's just really hard to get back to the point where you have, like, any normalcy with your just with your digestion.
Leonora:So for those moms that, you know, either don't want to take the meds, or kind of just in a gray area of, like, you know, maybe just not quite bad enough, so to speak, to take the meds, you know, you can you can do your little workarounds to try and keep your food down, but, ultimately, if you're losing a lot of weight, you know, we do really wanna make sure that we're we're trying to take corrective measures to to keep you to keep you well and to, you know, just make it so that your pregnancy is not miserable is kind of one of the main things.
Ciarra:Yeah. I I had a client who, gosh, this was in my 1st year or 2, had severe hyper harporemsis to the point where she was on a Zofran pump at home. And it was her 2nd pregnancy, and her first child was, like, 3. And she was saying things like, mommy, it's okay. I'll make my dinner.
Ciarra:And, like, going into the freezer and opening it, like, trying to it was so depressing and sad. And she was like, I am getting induced on my due date because I can't do this for 1 more minute of 1 more day. And so she did, which happened to be my daughter's birthday, which was kinda fun. So we go, and she she was tall and kind of like a ballerina's body. She used to be a ballerina, and we called her a baby smuggler afterward because she looked about 5 months pregnant when we walked in.
Ciarra:I mean, everyone was like, holy cannoli. This chick is real thin. Y'all, I just want you to feel better if you are out there with hyperemesis because she had a 9 pound 3 ounce baby in there with hyperemesis that entire pregnancy. And it's really difficult. Like, it's at a point where, yes, of course, there are risks to the medication, but, like, are you surviving?
Ciarra:Because we had a doula on our team who used you as her midwife. When it was her 4th baby, first home birth, she was so sick. She sent me a picture. She didn't even look like herself. Her she had the darkest circles under her eyes.
Ciarra:No one was listening to her before she hired y'all. She hired you and you were like, you do not have to live like this. And it changed her, you know, like, having that support from your provider because some just think, well, this is something you have to endure. And there is a risk benefit analysis to do there, and it's okay if you make the choice to take a medication to help you survive.
Leonora:I think that when it comes to, disorders and diseases that affect a 100% of women or birthing people, people with uteruses, they're very understudied. You know? Like, look at hyperemesis. Look at menopause. Anything that affects somebody with a uterus is going to be way less funded, way less understood, and way more prone to having health care practitioners be like, well, you know, it's a finite amount of time.
Leonora:You know? You're gonna get through it. It's fine. But that is whack. So, yes, if somebody is hating their pregnancy for any reason, you know, for nausea and vomiting, for psychological issues, you know, we are very much in favor of collaboration of care.
Leonora:You know, we have psychiatrists that we can refer to if somebody needs, medications that are safe to take while they're pregnant for their mental health. And, of course, we have maternal fetal medicine doctors who can do, infusions and prescribe Zofran, you know, or Phenergan or, you know, all sorts of different meds to to help keep you on the right track. I think that that's just it it shouldn't even really be questioned. But it's it's for some people, it's it's just a personal preference thing. You know?
Leonora:Some people just really are, like, I won't take medicine unless I'm dying. And I'm like, you do you, babe. You know, we'll just we'll just see the the options that that are available.
Samantha:Yeah. There's definitely a culture of women just have to suffer, when they're pregnant and, you know, once you're once you're through it, then you can you can treat whatever it is that's coming up, but it's definitely not the case. I actually listened to another podcast episode by, The Midwives Cauldron, which is one of my absolute favorite, podcasts out there. And they did an episode on pregnancy sickness and had a researcher, professor O'Reilly, I think is what his name is. But he's doing all of this research on pregnancy sickness and hyperemesis and medications, that can help with it and, like, things that you can do pre pregnancy if you had hyperemesis and another pregnancy to prevent it from happening.
Samantha:And it's, like, really cool stuff. And I really can't wait to hear what is gonna come from that because it's it's insane that we are in 2024, and we've just now started to figure out that there's like, oh, you could take some Zofran or you can take some Dicelogenous or whatever, unisom and b 6, whatever it is that's out there. We're just now figuring that out. So I don't know. That's crazy.
Samantha:Speaking of medications, though, kind of my last little question here. We hear on editing everywhere, radio, television, TikTok, everywhere about Ozempic and other weight loss drugs right now. And, actually, on Saturday night live this week, they had a sketch, in their weekend update that was about Ozempic babies. And I've been seeing this all over TikTok too about people getting pregnant on Ozempic. So what is what do you know, I guess, about the research showing about weight loss drugs and how they might be affecting fertility or pregnancy or whatever else?
Leonora:Yeah. This is something, I'm so curious to see where the data takes us because it's obviously a newer drug, but hit the market like a ton of bricks. Obviously. Like, people are super into it. And, you know, I think that, when it comes to making choices about our own bodies, like, I have zero judgment.
Leonora:Beneficial way and, you know, maybe they had a weight loss goal and they hit it and they feel better, Kudos. That's great. It seems like the mechanism by which people are potentially getting more pregnant while on Ozempic, I believe, is by weight loss. Like, you know, sometimes when when we are heavier, it's harder for us to get pregnant. But it does have an effect on our insulin resistance.
Leonora:And so I am really curious to see, because I think that, you know, if if a lot of people are getting pregnant while they're on Ozempic, we'll start to know within the next few years or so, like, if if that does have effects on the baby's insulin resistance. And, you know, if we are looking at a pregnancy that, you know, in the rebound effect of getting off a med like that, that they're more likely to have gestational diabetes. Because we all know that when you diet or when you take a med to lose weight, you know, there's the maintenance phase, and then you get off of it, and it rebounds. You know, it's not it's not ever just like we lose weight, and then it just stops forever, and we can just go back to eating carbs, la la la. You know?
Leonora:So, yeah, I don't know. I'm I am cure I'm very curious about Ozempic, and, you know, it's it's just coming from a place of of curiosity, not of judgment. But I do, I do wonder what what these pregnancies are gonna look like and how these babies will do.
Samantha:There's definitely gonna be some some questions, and I'm sure answers are gonna come up over the next, you know, couple of years. It really it feels like it really did just blow up. Like, I'd never heard of it before, and then now it's all anybody ever talks about. Like, Kelly Clarkson, Whoopi Goldberg, Melissa McCarthy, like, all of these women that are losing, you know, crazy amounts of weight are doing it with the help of these weight loss drugs. And then we're hearing from other women that they're getting pregnant while on these weight loss drugs, you know, accidentally or on purpose, and it you know, it'll definitely be interesting.
Ciarra:It's hard because there's not enough time that's gone on, so we don't know much yet. And so it's kinda like, you know, this generation of people is the guinea pigs of what this is going to do. You know,
Leonora:when it comes to the history of weight loss drugs, when you look back, over the years as to, like, the types of medicine that have been prescribed with absolute impunity to all sorts of people, it's it's not pretty. I mean, you know, Fen Phen, people were dropping dead of heart attacks, and they were like, well, you know, maybe maybe it's not this way. Shouldn't have done that. Yeah. Yeah.
Leonora:You know, it's it's crazy. And, like, prescribing weight loss drugs you know what? I could talk about this all day. But, like, to children the idea of, like, children losing weight, like, it's it's a lot. But, yes, that that will certainly be an interesting thing to find out about in the future.
Samantha:When all the research studies come out in, you know, 2025 and 2026, we'll do a whole other episode just dissecting them all.
Leonora:Absolutely. What I'm waiting for is the COVID data. I wanna know about, like, COVID effects on pregnancy and Mhmm. And the baby and the birth and the blood clots and all of that. Like, I'm like, where is the data?
Leonora:I wanna know.
Ciarra:Samantha is your data queen right there. She's been dying for that too.
Samantha:I'm all I'm dying for it. I'm so ready because I see it. We see it.
Ciarra:This while y'all talk on that one. I'll just be listening to your brain.
Leonora:I wanna I wanna know. I'm, like, gagging data as the kids would say.
Samantha:It's just interesting. It's cool to learn about. It's it's not coming from a place of judgment. It's just this is our bodies. Like, this is the world that we're living in.
Samantha:We're experiencing all these crazy things, and it's cool to see what it's doing, why it's happening, how, you know, how it's going to affect future generations and, you know, whatever else. I just I think it's a really interesting aspect of being a human. So Yeah. Anyways, thank you so much for coming on and having this, really important and slightly chaotic, conversation. I think it's it's important, and I think this is helpful for people.
Leonora:Yeah. I think it's one thing I would love to conclude with, it is that if you are getting blanket advice from your health care providers to lose weight in response to things like getting a UTI, having an ear infection, you know, anything, you need to find a new health care provider because that is a outdated mode of thought, and it's actually dangerous because people in larger bodies are less likely to get health care because of these reactions. So, you know, if you're trying to get pregnant or you're pregnant and your health care provider is, you know, making a big deal out of your weight despite the fact that you are making great choices for your body, you might consider finding someone else.
Ciarra:I love that. Yeah. Thank you so much. And we are gonna be doing more episodes with Leonora because we love her brain, and, we will have her back soon. So thank you so much.
Leonora:Yay. Thanks.
Ciarra:Thank you for joining
Samantha:us on Birth, baby. Thanks again to Longing for Orpheus for our music. You can look him up on Spotify. Remember to leave a review, share and follow wherever you get your podcasts. See you next week.
