By: Melissa Willets

"If you're like me, your answer to the question: "Should I have another baby?" changes by the hour. I gaze at my sleeping, angelic children, snug in their beds at night, and think, YES! Definitely, the sooner the better, NOW. Then my kids are screaming, fighting over a single, blue crayon, and it's, NO! NO! NO! No more kids, ever.So how do you cut through those everyday moments of indecision, to get to the real answer of whether you should have another baby? Try asking yourself these six things:

1. How do you feel when you get your period?
Is it, relief or sadness? Last month my period was a welcome relief. I have a 10-month-old baby, a three-year-old, and an almost six-year-old. We've got enough going on! But this month it was different. I felt a little sad, and began to think, what if? What if our family is not quite complete yet? What if we had another baby?

2. How do you feel when you see a newborn?
Do you feel love sick, or just sick? I see an infant, and my heart swells. An involuntary, "aww," escapes my lips. I can't help it! I love how a newborn smells, I love her soft, delicious skin. Babies are heaven, pure and simple. And having another one is starting to feel like the greatest idea ever!

3. What do you picture your life to be like with another child?
Is life overwhelmingly hectic or charmingly challenging? I don't picture a scenario replete with loud crashes, screaming children, me trembling, gripping a too-full glass of wine, crying in frustration, as little people slowly take over my house, and my life. Instead, I see happiness. I picture smiles, hugs, cuddles, love and giggles. Oh, there's craziness too, believe you me. But mainly I hear The Beatles' song "All You Need Is Love," playing in my head when I imagine being a mom to four kids.

4. What would life be like if you didn't have another baby?
Arrow straight through the heart. Ouch. No, the truth is I've felt conflicted about having another baby for a while. Life is great the way it is. Life is full. We are parents to three, beautiful, funny, silly, smart, wonderful girls. Why mess with what is working pretty darn well for us? When I think this way, another baby seems like a bad idea...

5. What is your biggest reason for wanting another baby?
Is something still missing? Or, is it just hard to imagine closing that door yet? There are so many reasons I want another baby. I still long to feel a baby kick inside of me. I yearn to hold a newborn in my arms, knowing that I did that; I made that. I have also loved, loved seeing how my children love, and care about each other. Being witness to their sisterly bond has been the greatest privilege of my life. I know that adding to our family would just bring more love, and joy.
​
6. What is your biggest fear about having another baby?
I worry about tempting fate if we have another baby. Can I really be lucky enough to bring four healthy babies into the world? No one could be that lucky; it just isn't fair. Right? Sigh. I don't know."
​

By: Nourish with Melanie McGrice

"So you've just found out you are pregnant, congratulations!! It’s an exciting and happy time. But, it can also be very overwhelming!

​If you’re wondering which foods to avoid when pregnant, you've come to the right place. In today's episode of Nourish, prenatal dietitian Melanie McGrice reveals her list of the 21 most important foods to avoid when pregnant, and when you can eat them again.

Enjoy!"

By: ​Hilary Braaksma

"Pregnancy puts a lot of strain on your body, including at bedtime, which is why finding the best pregnancy pillow is so essential for many women.

Find a little relief for those aches and pains by sleeping with a pillow that’s designed to cradle and comfort your pregnant shape. The latest pregnancy pillows come in a wide array of sizes and shapes to fit your particular needs, whether you’re looking to alleviate back pain or to find a positioning solution as a stomach sleeper

From full-body styles to wedges, the options are plentiful. Some favorite brands include Boppy and Leachco, but they’re not the only brands to shop for some of the best pregnancy pillows available in 2020. Below are seven pregnancy pillows we recommend for an amazing night of sleep."

Moonlight Slumber Comfort-U Total Body Support Pillow​

"​The Comfort-U Pillow by Moonlight Slumber cushions every curve of your aching body with Fusion Foss fiber. It feels soft and stays soft, but it also provides support where you need it most with its classic “U” shape. This is the perfect pregnancy pillow if you want to feel like you’re engulfed in a giant cloud. ($99.95; amazon.com)"

​Boppy Total Body Pillow in Ringtoss

By: Cedars-Sinai Staff| October 21, 2019​

"The biggest misconception women have about exercising while pregnant is that they can't do it at all, says Dr. Keren Lerner, OB-GYN at Cedars-Sinai. "It's not uncommon for women to wonder if working out during pregnancy will put the baby at risk," says Dr. Lerner. "I get asked that a lot."

Not only is it safe for pregnant women to exercise, but engaging in physical activity while pregnant can be beneficial for the health of a woman and her baby.
It can reduce the risk of preeclampsia, gestational diabetes, and hypertensive disorders during pregnancy. It can also minimize discomfort.
The American Pregnancy Association recommends at least 30 minutes of physical activity every day for women who have a normal, healthy pregnancy. 

The best types of workouts for pregnant women
It's important to know that not all pregnancy workouts are created equal. 
Dr. Lerner says workouts like Barre and Pilates are great because they focus on core strength, which can make the delivery and recovery process easier. 
"Prenatal yoga classes can be great for mind, body, soul, and core," Dr. Lerner says, as long as women are careful not to overextend their backs with deep bends or twists.
She also recommends swimming, especially in the third trimester.
"When there's more weight being carried, a lot of women end up with back pain," Dr. Lerner says.
"Because gravity is less of an issue in the water, women tend to be more comfortable in the pool."
No matter what workout they choose, pregnant women should drink plenty of water and take a rest if they start to feel dizzy or lightheaded while exercising.

​Workouts to avoid when pregnant
All pregnant women should avoid contact sports, as well as activities like skiing, snowboarding, rock climbing, horseback riding, and scuba diving.
If the pregnancy is high risk, women should talk to their doctor about their workout options.
Women should also seek medical advice if they get injured while exercising.
While 30 minutes of daily activity during pregnancy is recommended, women who enjoy working out aren't limited to this, Dr. Lerner says.
"Certainly those who are used to working out or have active jobs or lifestyles can endure more," Dr. Lerner says.
"They just need to be sure they're listening to their bodies." 

"How can you tell if you're struggling with mental health during pregnancy and postpartum?"

By: Women's College Hospital

"Women who had Covid while expecting experienced guilt, shame and unhealthy levels of stress."

"Kate Glaser had chalked up her exhaustion to being 39 weeks pregnant and having twin toddlers in the house. She also wondered whether her flulike symptoms were a sign that she was about to go into labor. But when she woke up one morning with a 100.4-degree fever, she called her doctor and got a rapid Covid-19 test.

Two nurses came to deliver her results to her in the waiting room. They were dressed in full gowns, masks, face shields and gloves.

“I knew by the eerie silence and the way they were dressed that I was Covid positive,” she said. “It was an emotional moment; I felt really disappointed and shocked and, as a mom, I felt a lot of guilt. What did I do wrong?”

Glaser, who lives in the Buffalo, N.Y., area, returned home and isolated from her husband and the twins in her bedroom, where she spent hours mentally replaying all her activities leading up to the positive test result. She also made a public post on her Facebook page about her positive status, and what she was feeling — guilt, embarrassment and panic. The post went viral, and Glaser started hearing from women around the world who were pregnant and worried about Covid-19. The majority of the of the 2,300 comments she received were supportive; a few were harshly critical.

“I was going down a rabbit hole of guilt and stress,” Glaser said, adding that for her, as much as the physical symptoms were bad, the mental stress of Covid was much worse.

Prolonged stress can have real consequences on pregnant people even outside of a pandemic and has been tied to low birthweight, changes in neurological development and other health impacts in children. And the pressure associated with a positive Covid-19 test increases these mental health risks.

The anxiety is not without reason. As of November 30, there have been more than 42,000 cases of coronavirus reported in pregnant women in the U.S., resulting in 57 maternal deaths. U.S. health officials have said pregnancy increases the risk of severe disease for mother and child, and being coronavirus-positive in late pregnancy may increase the rate of preterm birth.

Prenatal care and birth plans are also disrupted by a positive test result. “Women are expressing so much fear about being infected, but also about going to the hospital, delivering and being separated from their child,” said Laura Jelliffe-Pawlowski, an epidemiologist who is the primary investigator of HOPE COVID-19, a new study that focuses on the well-being of women who are pregnant during the pandemic.

The study launched in July and will follow more than 200 women around the world, from pregnancy to 18 months postpartum, to understand how Covid-19 and the pandemic response impacts pregnancy and infant health outcomes.

Dr. Jelliffe-Pawlowski and her team have analyzed the data from the first group of women, and they are finding “absolutely incredible” levels of stress and anxiety. “Sixty percent of women are experiencing nervousness and anxiety at levels that impede their everyday functioning,” she said, citing preliminary data. “There are a number of women, particularly lower-income women, expressing how hard it is to choose to stay in a job that puts them at risk versus quitting the job and not having enough food for their baby.”

Nearly 70 percent of the participants reported feeling worried about decreasing family income and more than 22 percent worried about food insecurity (though none had experienced it at the time of the survey). Dr. Jelliffe-Pawlowski worried that women were not necessarily getting the psychological care they needed: “If you can’t feed your family, seeking out mental health care is not your top priority.”

She also said more than 84 percent of women reported moderate to severe anxiety about giving birth during a pandemic. “Many women do not want to get tested because they will be stigmatized or separated from their baby or not allowed to have people in the room to support them,” she said. She added that similar visiting rules often hold true for babies in the NICU after being born preterm during the pandemic: Only one parent can be present in a 24-hour period. “It’s heart-wrenching to see families go through those choices.”

Dr. Jelliffe-Pawlowski is particularly interested in how stress impacts births and long-term outcomes for children as psychological stress is highly associated with preterm birth. After the attacks of September 11, 2001, the risk of preterm births almost doubled for people living near or working at the site of the fallen towers. She’s also concerned about long-term effects of stress and anxiety on maternal bonding during the pandemic.

Margaret Howard, a psychologist at Women & Infants Hospital in Providence and postpartum depression researcher at Brown University thinks it is absurd for pregnant women who test positive for an infectious virus to bear any guilt or stress associated with their diagnosis: “Are moms in a special category where they are expected to not get Covid? What about a sinus infection? Hay fever? Cancer? Why is Covid a moral failing for mothers?”

When Erica Evert, a pregnant mom in northern Virginia, received her postive Covid-19 test result, it didn’t make sense. She was near the end of her pregnancy, and hadn’t left the house in four and a half months, except for ob-gyn appointments to check on the baby.

“My first thought was, is this a false positive? I feel fine. And my second reaction was to start bawling,” said Evert. She was scheduled to have a cesarean section with her second baby and the test was merely a formality — until it was a life-changing event.
​
The hospital gave her a choice: She could deliver the next day and be treated as a Covid-19 patient — separated from her baby with no skin-to-skin contact, per the hospital’s policies. Or she could wait 10 days from the date she received the positive test result and deliver with her regular plan. She had four hours to make a choice she wasn’t expecting. “I kept thinking: am I going to make a decision that results in my child dying?” said Evert."

"Registered Dietitian Tracy Lockwood Beckerman gives tips on the most nutritious foods to eat to support your baby in each trimester of your pregnancy."

​By Erica Chidi and Erica P. Cahill, M.D. | October 22, 2020

"The data is heartbreakingly clear: Black women in America have more than a three times higher risk of death related to pregnancy and childbirth than their white peers. This is regardless of factors like higher education and financial means, and for women over 30, the risk is as much as five times higher.

While the recent national dialogue created in response to the data has been a critical leap forward, it has also brought up a lot of fear and questions from Black women about how we can prevent these outcomes.

Last year, we sought out resources to help Black women navigate their prenatal and postpartum care in light of this knowledge, but came up empty when looking for a resource that explicitly called out encountering racism during this time and how to tackle it.

As a result, we partnered to create an education guide that would offer pregnant Black women agency when planning their care (which, in most cases, would be with white care providers). We felt it required an allied, intersectional perspective that acknowledged the importance of care providers and health educators working together on behalf of patients.
​
We aimed to have a discussion with medical racism and antiracism at the center, especially since increasing evidence points to the effects of structural racism as the reason for this mortality inequity. Medical racism is present whenever health care professionals or institutions alter the diagnostic or therapeutic care provided because of a patient’s race, particularly if the decision puts the patient at an increased risk of poor outcomes.

We wanted to inform Black women of the unique risks they could encounter during their pregnancy, birth and the postpartum period, as well as what they could do to prepare for them. This guide is meant to help Black women feel safer, and to provide a modern framework for medical providers to actively address their own racism."

​By Hilda Hutcherson| September 4, 2020

"Caroline’s mother was concerned when she turned 15 and hadn’t had her first period. It finally came, but it wasn’t until three months later that she’d get her second. Her gynecologist assured her that irregular periods were common for someone her age, so Caroline’s mother didn’t worry. Then, at 18, her periods disappeared for six months. This time, her college ob-gyn said that the stress of college often causes menstrual periods to wane, and that the best treatment was hormonal therapy to make her periods regular. So she started taking birth control pills.

Thirteen years later, she was ready to have a baby and stopped taking them, assuming that since she was older and not under as much stress, her periods would become more regular. But they didn’t. She also noticed increased acne and facial hair. After six months of trying unsuccessfully to conceive, she started taking her temperature and using an ovulation predictor kit. Both revealed that she was ovulating infrequently and irregularly. The question was why?

Many women with irregular periods are told it’s no big deal. Even her acne and facial hair didn’t throw up a red flag. Fortunately, tests eventually led to an accurate diagnosis: she had polycystic ovary syndrome (PCOS), a hormonal disorder that disrupts women’s fertility and may cause a host of other health issues. As many as 15 percent of women between 18 and 45 have PCOS, making it the most common hormonal disorder among women of childbearing age.

For this guide, I reviewed the current literature and interviewed Beth Rackow, M.D., a reproductive endocrinologist and director of the pediatric and adolescent gynecology program at Columbia University Irving Medical Center.

What to do: 

• Know the signs and symptoms
• Know what’s involved in diagnosing PCOS
• Understand how PCOS may affect your fertility
• Prepare for potential pregnancy complications if you conceive
• Know the other health risks of PCOS
• Consider possible treatments

Know the signs and symptoms
Polycystic ovary syndrome is a common hormonal disorder among women, yet often goes underdiagnosed by health care providers. Some women have few, if any, symptoms. Others have many — irregular or absent periods, excess facial or body hair growth (hirsutism), obesity and infertility — but they may be mistaken as signs of other health conditions.

​Irregular, unpredictable periods are one important symptom. Periods may come twice a month, be infrequent (greater than 35 days apart) or disappear for months at a time. They may be light or they may be heavy enough to cause anemia. You may suspect PCOS if you also have acne that doesn’t respond to treatment or increased growth of facial or body hair. These are signs of excess androgen hormone. Eighty percent of women with hirsutism have PCOS.

PCOS may appear as early as adolescence. “Girls with PCOS typically present when they haven’t had their first period when they should have, their periods are very infrequent or they are having frequent, heavy periods,” said Dr. Rackow.

It’s common for menses to be irregular in girls during the first year or two after the first period. Acne is also common during adolescence. However, if menstrual periods continue to be abnormal after the first two years, or if bleeding is persistently heavy at any time, an evaluation is needed."

"Nima Bhakta was that college friend who everyone knew would be a great mother.

We met in 2006, and I could see that she was always at ease when she interacted with children.

Kind and confident, she was also the friend who talked about how excited she was to have children of her own.

That's why it was such a devastating loss to her family, friends and to me, when she lost her battle with postpartum depression and died by suicide on July 24. Suicide is one of the leading causes of death in women with postpartum depression.

In a letter to her family before she died, Nima wrote that she tried to tell her loved ones about her struggle with postpartum depression but she hadn't been able to find the words to explain the depth of her suffering. She wrote that she had a loving and supportive husband and that no one was at fault for her pain.

It started, she wrote, after her son was born in 2019. She felt completely changed as an individual, wife, sister, daughter and aunt, and she didn't understand how she couldn't even attempt cooking or other things that she once enjoyed.

Her constant worry about the future and self-blame for any difficulties with her son overwhelmed her. She got to the point that she believed that she was a complete failure as a mother and was scared that she would cause him harm in the future. Throughout her letter was a sense of shame for needing help taking care of her son, and guilt that she wasn't feeling better despite having an incredibly supportive husband, Deven Bhakta, and her sisters and family.

In her text messages to me she expressed she was experiencing postpartum depression. "Everything I do for Keshav just seems like a task for me, it's been hard to have that bond between me and him. Really didn't expect all this since I love kids but with Keshav I've been struggling. I haven't been out of the house either unless it's for a doctor appointment, it's pretty bad. Deven's been such a big help it's ridiculous."

She couldn't see what a wonderful mother she was to her beautiful baby boy. I saw her as a devoted mother diligently attending to all of his daily needs. I could see she loved him so much.

How did a mother who didn't have any of the risk factors for PPD -- factors that include a personal or family history of depression and lack of social support -- still succumb to it? It can be harder for Indian women like us to ask for psychological help because these issues are not always discussed in our community, but there are other reasons women suffer from this misunderstood condition.

​What is postpartum depression?

During pregnancy and in the hours after childbirth, women experience a dramatic drop in their estrogen and progesterone hormone levels, and that fluctuation is thought to contribute to postpartum mental health problems, according to the American College of Obstetricians and Gynecologists.

In addition to the changes in hormones, emotional factors, fatigue and general life stressors may contribute to PPD, experts say. Postpartum depression may begin in the days or weeks following childbirth, or it may begin months later, and it can last weeks, months or years if untreated.

While the experience of PPD can look different for each woman, common symptoms include a loss of pleasure or interest in doing things she once enjoyed; eating and sleeping much more or much less than usual; experiencing panic attacks or anxiety most or all of the time; feelings of guilt, worthlessness and self-blame; sadness or crying uncontrollably; fear of not being a good mom; fear of being alone with the baby or disinterest in the baby; difficulty making decisions; and thoughts of hurting oneself or the baby.

Postpartum depression is not the so-called "baby blues," which 70% to 80% of all moms experience, according to the American Pregnancy Association.
​
While baby blues may begin soon after birth, its symptoms -- which can include crying for no apparent reason, anxiety, insomnia and mood changes -- should dissipate two weeks after childbirth. If they continue past two weeks, mothers should be examined for postpartum depression."