Tag Archives: Pregnancy

Two Follow-Up Articles to Read on Folic Acid in Pregnancy

Pregnant belly in black and whiteChoosing a supplement for pregnancy, lactation, and trying to conceive is daunting!  Dozens and dozens of prenatal vitamins exist!  How do you choose?  One important way to narrow it down is to choose one with a “natural folate.”  Recently, I ran two posts on folate/folic acid (here and here) and why people may want to steer away from folic acid use in foods and vitamins–but NOT folate in general–just the folic acid form.

Today I will post two really readable articles regarding folic acid versus folate in prenatals that readers may be interested in.  Remember, my blog is a story of what I am learning.  It is absolutely not to be used as medical advice.

Two Fairly Easy to Read Articles on Folic Acid in Pregnancy

Should you skip prenatal vitamins with folic acid?

(Click on article title to link to the article.)

This is a nice overview article from the news written in common language.  I think it summarizes the thoughts from my second post on folic acid versus folate (click here to read it).  Basically, those people with MTHFR (methyltetrahydrofolate reductase) issues would benefit from L-methylfolate rather than folic acid.  But how do you know if you’re “one of those people?”  Unless you’re tested, you don’t.  And in this article, it states that about 50% of women can be affected.  So you’re playing a guessing game.  Am I good with folic acid?  Or would I be better off with L-methylfolate?

If you’re trying to conceive, pregnant, or taking folic acid, this would be a good article to read to help you understand whether or not taking folic acid (versus folate) is best for you.

Multi-vitamin Supplementation During Pregnancy:  Emphasis on Folic Acid and L-methylfolate.

(Click on article title to link to the article.)

This is a nice little interview between an obstetrician and a nutritionist regarding L-methylfolate, folic acid, and MTHFR issues.  The conclusion is very similar to the article first listed (and similar to what I concluded), but rather than being in the general news, it is from an obstetrical journal.


The next post will discuss what I look for in a prenatal vitamin along with some vitamins that I looked at, but the take-away message that I learned is this:  If you don’t know your MTHFR status, it might be wise to stay away from folic acid supplements (but not folate).



Splitting Apart in Pregnancy: Diastasis recti

Today marks my entry into 37 weeks of pregnancy.  Likely, at least three more weeks to go as my body’s smooth muscle doesn’tPregnant belly in black and white seem to appreciate moving spontaneously, and I don’t have a pattern of early births.  (Sigh.)  Yeah, the last month of pregnancy hurts, but I try to savor the appreciation of how my family and life is right now, knowing that although it will be better, it will never be the same again.  This week I am hoping to push out several personal posts on pregnancy because once this pregnancy is over, I plan to not be lookin’ back.  Severe joint pain, nausea, headaches, moodiness, exhaustion, and constipation are not my cuppa’ tea.  However, definitely before I leave this golden field behind and while it is still fresh in my mind, I want to write a post on diastasis recti in case anyone else out there is dealing with this.

What is this strange pain?

I had heard of and seen things like round ligament pain, symphysis pubis pain, sacroiliac joint pain, acid reflux pain, and so on in training.  But early in the third trimester of my first pregnancy, I developed a very strange stretching, burning, pulling type of pain in the midline of my abdomen.  I knew from experience it wasn’t something serious–nothing coming from my internal organs.  But, dang!  It was uncomfortable!  I felt like my midline was literally being torn apart!  I asked my girlfriends who had been pregnant about it.  Nothing.  I asked my OB about it.  Nothing.  Just one more lovely thing about pregnancy to add to the tally!  And it was uncomfortable!

Post-delivery of Baby One

After pregnancy, I noticed when I’d sit up in bed, my midline abdomen would bulge out like one of those old-fashioned water bottles!  My husband, being the musculoskeletal expert in our family, said, “Hey!  You have a diastasis recti!”  My OB confirmed that’s what I had and felt it would improve with time.  It didn’t.  Okay.  It did improve some.  But I could still shove a ball somewhere between the size of a golf and tennis ball where my belly button used to be.  Beautiful.  Simply beautiful.  The battle ground of my belly.  I will never see the belly button of my childhood days again.

What is diastasis recti?

Think of a bodybuilder with the perfect six-pack (the six-pack muscle is made of several parts and is scientifically called the rectus abdominus muscle) .  The line dividing the six-pack right in half down the middle, placing 3 “soda pops” on either side, is called the linea alba (the “white line”).  Smack dab there in the middle from the top to the bottom of your midline, where your belly button lives, there is no muscle.  All that is there is a strong layer of connective tissue between the two halves of muscle, the linea alba.


When that strong layer of connective tissue becomes stretched wider and thinner than it ought to be, it is called a diastasis recti.  This can frequently occur in pregnancy with all the stretching due to size and hormonal changes that occur to loosen up our tendons and ligaments to allow our bodies to accommodate and deliver the baby.  It makes good sense for that sheath to be able to stretch out during pregnancy!  Unfortunately, in some women, the diastasis is quite large and doesn’t ever return to normal (or even close to normal).  These women have “mummy tummy,” distorted belly buttons, billowing out of the abdominal contents with abdominal wall contraction or gravity, and problems with core body strength!  If women don’t know about this condition, they may wonder why in the world their abdomens don’t shrink no matter how “skinny” they get!

I know for me, I was left with a large crater for a belly button, lots of extra skin right around the belly button, stretch marks only around the belly button, and a large ballooning out of the midline with trying to sit up.  On bad diastasis days, I get the “Mommy, you look pregnant” remark.  (That is–before I WAS pregnant!  In pregnancy, with a diastasis recti, you seem to really “pop” big in the first trimester and always look further advanced than you really are.  Another sigh.  How many times do you have to listen to the “Man!  You are big!” remark?)

My Subsequent Pregnancies and Discovery of an Umbilical Hernia

I didn’t really get any more of that horrible stretching sensation where it felt like I was splitting apart with Baby 2 or Baby 3.  I guess I was as split as I could be.  Shortly after Baby 3, I developed a kidney stone, requiring an abdominal CT scan.  The scan, aside from the kidney stones, showed that I also had an umbilical hernia–an actual hole in the linea alba right there at the belly button.  After a visit to my general surgeon for consultation, it was decided that the hernia was large enough that it would not “strangulate” any bowel.  With an umbilical hernia, sometimes loops of intestine can squeeze through the hole and get their blood circulation cut off.  The intestinal tissue strangulates and dies, leading to an exceptional emergency situation.  My hernia was big enough to let my intestine slip in and out unimpeded.  Yippee.

I carried on.  For me, it was a cosmetic issue only.  No bikinis or half-tanks.  Carefully chose apparel.  It never interfered in my ability to exercise and work-out.  I didn’t do traditional sit ups.  I wore Spanx if I had to for special occasions.  No biggie for me.  (I know other women have different stories to tell.)

Don’t Touch My Midline…

Then, I became pregnant again with Baby 4.  Ooh-la-la.  Ouch.  At about 13 weeks, when horrible bloating hit, my midline felt that horrible stretching sensation again.  Kind of like someone taking your ankle or shoulder and contorting the ligaments and tendons in positions they aren’t meant to go.  And it hurt and has only let up here and there throughout the pregnancy.  Coughing, bloating, laughing, trying to get off the couch or bed, and sometimes just sitting are painful events.  Pain like my kidney stone?  No.  But painful still.  And PLEASE don’t touch my belly in the midline!  The sides, where I still have good tissue support–fine, touch and push like the dickens.  But please not the midline!  Another wonderful blessing of a diastasis recti is the visibility of the uterus and baby parts right there seemingly under your skin!  Like it’s going to fall out of there or something!

The Belt

Baby Belly BandTo help with the pain, I invested in a belt after researching a bit on-line.  The belt helps.  Not completely.  I don’t wear it all the time because I don’t want to lose the core abdominal strength that I do have.  But when I feel the tearing pain increasing, I put it on and it kind of lifts up my belly, taking pressure off of the damaged linea alba.  Sometimes I wear it at night after a bad day.  Sometimes I wear it on a long walk.  If I’m having bad bloating, which also hurts it, I will wear the belt, too.  It comes with extra attachments.  (Doesn’t that sound so funny!?  Attachments.)  I have the “suspenders” and the “extra cinch” piece.  Here in the last 6 weeks I have just started needing to occasionally use the suspenders and extra cinch.  Before this point, simply the belt seemed like enough, as it is adjustable and has grown with me.  The belt is soft, but my pregnancy belly is itchy no matter what so I always wear the belt over a cami or undershirt.  A last point on the belt:  I have found that it helps my sacroiliac joint pain also.  Again, it doesn’t remove all the pain, but it really does reduce it.  I have never had another belt to try, so this is the only one I can vouch for.  To me, it has been worth it.  The belt I purchased was Baby Belly Band.  This is NOT a thin, stretchy type band to use for aesthetics or mild support.  I have those, too, and they are not the same deal.

Precautions I take

Although I’m an independent cuss, this pregnancy, with that ripping sensation resurfacing (at least in my mind telling me that my hernia is probably enlarging), I have turned over most all lifting so as to not make matters worse.  Makes me so mad to have to have others lift my water jugs.  To lift me up.  To move the furniture around.  To lift my sick 5-year-old.  But I know that is best and probably should have been standard with Baby 1!  I remember being in fine nesting mode with Baby 1, moving the couch here and there and snowblowing after a blizzard in the last trimester.  If this is you, stop it now!  🙂

I try to not use my abdominals to get up off the couch, bed or floor (when I make it down there).  I either wait for help up or use every ounce of arm strength to push myself up to some position where I can use my legs.  In addition to asking for help with pretty much all that requires abdominal use, I’ve rigged up a rope system to use to help me pull myself up out of bed at night for the standard 5 trips to the bathroom.  (I hide it when the cleaning lady comes.  Who knows what she might think that’s for!  As if!  LOL!)

Is there a way to fix it?

As this is a personal post, speaking off the top of my head, I’m not going to go into much detail.  There are surgical procedures that can be done.  The technique offered will differ based on many factors, including whether or not you have a hernia and even what kind of surgeon you seek out to do your procedure.  Many insurances will not cover this unless you are having some medical issues related to the diastasis/hernia.  Also, many doctors don’t recommend fixing them unless you are done with pregnancies.  So if I HAD had my diastasis/hernia repaired, the result could have been compromised by my current pregnancy.

Alternatively, there are physical therapy programs out there which try to address the diastasis.  There are a few of them which I’ve read about.  Some people report good success and some don’t.  (Imagine that.)

There are binders out there.  This is not a fix, but I know that my diastasis is hugely apparent during the months after delivery.  At this time, I do often wear a binder to “hold it all in.”  It doesn’t work permanently for me, and again, I like to make sure I’m never putting my own core abdominal strength in peril due to a binder, but it does “bring it all in” temporarily for me.  This is different from the belt/band I describe above.  It is much wider to wrap around your entire midline section–or at least much of it.


So if you have this splitting feeling in your midline with pregnancy which you’ve discussed with your doctor to rule out the “bad stuff,” maybe check out the term diastasis recti on a computer search.  Or, if after reading this you think, “Yeah!  That’s me!  I have a diastasis recti still!”  Search.  You’ll find a lot more than I’ve got summarized here.  This post was not for diagnosis or treatment.  It was a sharing of my story to heighten awareness.  Wishing you joy in parenthood and life.


“My” Diet Has Not Helped My Pregnancy Sickness

Fresh blueberriesThe Food-Health Connection Is Real

Discovering the power of food changed my life about two years ago.  Although my mom isn’t very happy with me, I just can’t tell you how much better my husband and I feel (and we wouldn’t even have been considered “unhealthy” by most in the first place.)  Invincible.  Empowered.  THIS is where it’s at.  Let my friends, family, and (ex) colleagues think I’m crazy, I’ve decided this food stuff is no voodoo.  Medical doctors have their heads buried deep in the sands of guidelines and HIPAA and OSHA and Medicare check boxes–they are NOT making time to learn about this stuff.  I didn’t make time when I practiced and trust me, it’s not a part of required typical continuing medical education.

Countless food journals, diligent symptom logging and persistent elimination/reintroduction phases have led our family to be able to control most symptoms we used to medicate.  I never, ever would have believed this a few years ago as a practicing physician, and I sometimes think I must be “goofy” to believe it even now.  Occasionally my medical brain–which I paid so much money for–insists on denial that a real food-body connection exists.  That’s when my husband just shakes his head, “Why’d you eat it?  Why?”

They Said, “Maybe It’ll Be Different With ‘Your’ Diet!”

So I’m all about nutrition nowadays, and if I don’t watch it may put too much store in it.  But life is about learning.  (Homeschooling, if you will.)  And the last few months I had to learn that sometimes even the best diet fails and you truly are helpless to the whims of internal physiology and biochemistry.  (I DID know that already, really, but I guess I needed to FEEL it.)  In November, I was feeling so great.  I felt like all my hard nutritional work over the last two years was really, really paying off, and I was even starting to reintroduce some problem foods with a little success.  Then I got pregnant.  Oh, boy.

Friends and family get informed very early when I am pregnant.  (Sometimes store clerks do too when I lock myself out of my car or forget my wallet.)  None of this waiting 12 weeks here to tell.  Withholding information only serves to make me seem quite irritable, neglectful, and remiss to others if they don’t know “the secret.”  Plus, I have miscarried in the past and people didn’t know I was pregnant.  The first they hear about it is when I’m headed to the OR for a D & C.  “I didn’t even know you were pregnant!”  Nice.  Sob.  I was.

Well, anyway, this fifth time around, many people exclaimed,   “Maybe ‘your’ new diet will make the sickness not so bad!”   I secretly hoped with them. I was secretly confident. I was eating great and had been eating great for two years!  All the recommended “voodoo” stuff:  broths, liver, seaweed, tons of organic vegetables, pastured meats, avoidance of inflammatory foods, some fruit, probiotic, magnesium (plenty of that!), B vitamins, fermented cod liver oil.  What am I missing?  My body was armed and it was ready.

Despite “My New Diet” Pregnancy Symptoms Chewed Me Up.  (Just Like All the Other Times.)Zucchini pizza

The nausea increased and increased. The overwhelming exhaustion consumed me. Odor aversion sickened me all day. Food cravings and aversions hit.  I was so hungry all the time but so nauseated. Some foods left horrible tastes in my mouth. I over-salivated like a loving puppy (medical terms for hyper-salivation: ptyalism or sialorrhea). No matter what I ate, the sickness continued.  Bloating kicked in to the point it hurt.  Constipation fluttered back in and out as it wished.

About the time the nausea started lifting at the end of the first trimester, I got a new twist.  Horrible, migraine-like headaches and an apathetic, flat mood.  I felt like I had gone out of the hot pot of typical morning sickness and into some frying pan. Since adhering to “my diet” clearly had not helped in the first trimester, I had gotten mad in the throes of it and let in foods which I don’t normally eat/eat much of (like egg yolks, nuts, potatoes, tapioca bread, and rice).  “What difference does it make?” I thought.  “I feel horrible one way or the other.”  (Just an FYI.  I tried a cheese quesadilla, a real one, and it was unmistakably unacceptable.  Guess you can feel worse than worse with certain food choices in pregnancy.)  Mess with my GI tract but please don’t mess with my brain.  When my head started getting “attacked,” I ran back to the safety of “my diet”–the home-tailored GAPS/PALEO/SCD/Autoimmune PALEO diet that had got me feeling so good.  I don’t know that it helped, but it offered me some sense of control.

Despite feeling so good prior to pregnancy and eating so well early on, it was turning out NO differently than all the other four pregnancies.  How could life have selected for pregnant women to be so sick?  I would have had to have been left behind by the tribe 10,000 years ago!  Left to die holding the prized liver awarded to pregnant women back in those days.  “Bye-bye.  See you guys.  Thanks for the liver.  I’ll run from wolves the best that I can.”

This isn’t my first pregnancy.  I’ve Googled all this “morning sickness” (it’s more than just nausea–it’s overwhelming exhaustion, smell aversion, increased salivation, headaches, you name it) stuff before seeking relief.  I’ve sat through lectures on it.  I’ve counseled patients on it during obstetrical rotations in residency.  I’ve tried this and that and this and that.  But I searched again.   A re-Google did NOT help.  I found things like “The Real Cause of Morning Sickness”, which pinpoints diet, magnesium, and B vitamins.  I was so mad.  “The Real Cause of Morning Sickness,” my foot.

Garden broccoliChin Up and Eat Nutrient-Dense Choices For Two

All this nutrition “jazz” worked for the author of that post and other similar posts out there.  But here is MY post saying, “Hang in there, chic.  Despite your best diet and supplements, pregnancy-induced sickness may bark up your tree.”  It is barking up mine.

I’ll be the first to back nutrition and say you gotta’ try it.  You gotta’ eat right.  I’ll tell you to try to play it safe and not eat some of those urging craving choices, like a cheese quesadilla.  But I’ll admit when I’m defeated, too.  In the Food vs. Pregnancy battle, Pregnancy won here in this house–despite copious pre-pregnancy magnesium, B rich meats and vegetables and supplement, and vitamin D enrichment.  So if this is you, too, it’s okay.  Chin up.  It doesn’t last forever.  Your body is just doing its job and for some reason that makes you (and me) exceptionally uncomfortable.  Eat the best you can and stay in the game.  Don’t let miserable pregnancy symptoms knock you too far off your nutritional choices and goals.

Even if it doesn’t make our pregnancy symptoms better, we have to come out of this pregnancy as strong as we went in.  Baby will take what baby needs.  Reproduction is numero uno in life.  So eat well to make sure you have enough for BOTH of you!  I didn’t come out of pregnancy four very well:  kidney stones, daily headaches, allergies, exhaustion, achiness, and hormonal issues.  I’m determined to come out of this one better than I went in.

Has “Your Diet” Helped Anything?

Yes.  Typically no matter what pre-pregnancy weight I start at–I’ve started anywhere from 135-148 pounds–within the first trimester my weight soars to about 160 pounds.  Seriously.  Right off the bat.  I thought it was just me and my body.  I never fretted since it happened every time and I was healthy.  I always gained over forty pounds each pregnancy.  And each baby has gotten successively bigger–7 pounds, 8 pounds, 9 pounds.  So I’m curious to see how much weight I gain and what this baby weighs.

This time around, I’ve gained 6 pounds and I’m at 16 weeks.  I haven’t done anything except put forth a tremendous effort to stick to whole foods–call it Paleo, GAPS, SCD, whatever you wish, I don’t care.   I’ll be interested to see if it holds.  But as for all other pregnancy associated symptoms, my diet has not helped.  But I know it’s going to help me tremendously in the recovery period.  (And if it doesn’t, I’ll let you know.)

How Far Do I Shake My Conventional Training?

I’m beginning to think about things I’ve never thought about before.–Do I want my baby to get a hep B vaccine at Interior of a passion fruitbirth?  How about vitamin K?  Should I have them delay clamping and cutting the cord?  What’s this strangeness about eating the placenta?–I know you have more.  So lay them on me.  Food is no longer voodoo to me–but all this other stuff is.  So throw these new sacrilegious ideas out there to let me decide how many waves to make at the hospital.  (I’m a conventional medical doctor.  Bear easy on me.  I love to investigate the validity of these new ideas, but my choices will be skewed by my experiences.  And although I already told him to prepare for some waves at the hospital, my husband is slower than I am to embrace conventional medical practice–but still a great trooper.)


First Trimester Yucks

We have had a little surprise in our house that has brought me to my knees.  Probably I should say it has brought me to my couch.  For a couple of months.  Finding humor in the midst of discomfort brings some relief.

How long will this first trimester last?  One year.  Let me explain the math.  Anything that is miserable has to be multiplied by a factor of 4.  A trimester equals three months.  Three months multiplied by 4 is 12 long months.

Irritated one morning–before I even thought:  “WHY is this bathrobe making be look so frumpy?  It makes me look three months pregnant or something! “ Guess that would be because I was ONE month pregnant!  Size must get multiplied by a factor of three.  Later it will be 5 or 6.

I’m late.  Maybe I should check a test.  Nah.  Just my hormones.  Why waste money on a test that always comes back negative?  (Wait.  Wait.  Stop.  Where is that box with the “code”?  Is this kind of test positive with a plus sign–or positive with one line–or positive with two lines?  Oh, can’t they standardize these stupid sticks?)  Stupidity must get multiplied by a factor of 10-100.  MY stupidity, that is.

Gastric motility (how quickly the stomach empties its contents) slows down in pregnancy.  How much?  Just eat a cucumber.  One hour.  Two hours.  Three hours.  Four hours.  Five hours.  About 6 hours to empty the stomach by my calculations.  Typical stomachs dump their food out in about an hour.  Multiply by a factor of 6 for gastric emptying.  Probably best to skip the fermented cod liver oil for awhile.

I have no idea what my kids are doing around the house.  The other day one came up from the basement repeating, “One time, at band camp…”  What’s that supposed to mean?

Sleep definitely gets multiplied by a factor of about 2 to 2.5.  Up.  Take a shower.  Lay back down.  Put on clothes.  Lay back down.  Drag out Lara bars.  Lay back down.  Don’t get back up…

What’s unschooling?  I will definitely be looking into that philosophy.  They don’t need multiplication anyway.

Your deodorant is like a shotgun up my nose, please don’t hug me.  Your shampoo I can smell, and it is death by odor.  Please don’t snuggle me.  You stink.  Oh, by all means cook for me, but can you grill outside in the Alberta Clipper so the smell doesn’t linger in the house?   No.  I can’t go to church today.  Too much perfume.  Please.  Even the dishwasher smells bad.

You.  Man.  Go away.  Don’t you come near me.  I’ve heard you can get pregnant twice.  You can see I learned as much about sex education as I learned about saturated fat and gluten in medical school.  Yes, I really need my money back.

I wonder if working out would make me feel better.  Pedal.  Pedal.  Two revolutions.  Can’t do this.  Maybe the incline treadmill.  Nope.  Not that either.  I’m going to go stretch on this yoga mat (while I sleep).

I have done this five times in my life.  If you multiply (multiplication–again) three months by 5 months, that’s 15 months of my life feeling sick and doggy.  Women are clearly the stronger sex.  And sometimes, some of those first three months amount to only an angel in heaven.  But two days ago we had a heartbeat at 12 weeks, so we are statistically a lot closer to a beautiful blessing that I will have joy for once I quit feeling so badly.

photo (1)P.S.:   I wondered as I started this nutritional intervention path two years ago if it would have made any difference in pregnancy symptoms and issues.  I NEVER intended to personally check it out.  Ah, well.  Life is good if you change your expectations sometimes.  (Those Lifesavers I did not eat.  Strangely, their smell calmed my stomach.  I did eat them all the other pregnancies, and eating them never helped.  Smelling them did.  Yep.)   ~~Terri