4 THINGS THE PREGNANCY/POSTPARTUM BOOKS MISS

Date: March 15, 2025

As an OB/GYN (before I retired) I helped around 10,000 women navigate a pregnancy and give birth. That’s a lot of experience! However – I think we all know that you learn the most when you personally experience something and having two children of my own DEFINITELY expanded my knowledge. A newsletter is not a great place to cover all the complex changes that occur in a woman’s body during pregnancy and delivery or to tackle all the issues that can arise that complicate a pregnancy or delivery. There are many great books available that walk you through the “technical” aspects of pregnancy and delivery. What is happening first, second and third trimester, what are the stages of labor etc. So in this newsletter I will be covering some important pregnancy topics that are not always outlined in the popular/traditional books or even discussed in your OBs office.

DISCLAIMER: I am just presenting my thoughts and prejudices formed over a long career and shaped by my experiences. I hope the information expands your knowledge, is thought provoking and helps you formulate your own opinions. Armed with knowledge you can then find a preferred provider and have informed conversations with them. The goal is to appreciate and enjoy this stage of life and to have a healthy outcome.

Alright now – let’s dive in… 🤰🏼🤱🏻

4 THINGS THE PREGNANCY/POSTPARTUM BOOKS MISS…

I’m going to start with a SURPRISING PERSPECTIVE that seems to get ignored. The pregnancy books concentrate on the baby – the stages of development, baby’s nutritional needs etc. Obviously important information. What I want to point out, however, is that pregnancy is not just about the birth of a baby – it’s also about the BIRTH OF A PARENT (you’re embarking on a lifetime journey). Being pregnant and giving birth will change YOU. Pregnancy in fact seems to make it easy for women to “MORPH”.

While trying to conceive or when pregnant, I have seen women TAKE ACTION and make changes that previously they thought were impossible. I want to bring to your attention how during a pregnancy you can LEVERAGE THE EXTRA MOTIVATION you will be feeling to do two important things:

1️⃣ PREGNANCY IS A GOOD TIME TO DEVELOP A GENERAL MEDICAL PHILOSOPHY

Pregnancy is a precious time- there will be many scenarios where you will have to choose what is best for you and/or the baby. A MOTHER WILL NOT HAVE TOTAL CONTROL OVER THE PROCESS – BUT PREGNANCY IS A GOOD TIME TO DEVELOP A GENERAL MEDICAL PHILOSOPHY. Taking the time to do this will actually help you throughout your life as you deal with medical issues of your own and of your family.

First let me state that pregnancy and delivery are natural processes that innately the body “knows” how to do. Having helped so many women – I would emphatically tell you that the MAJORITY of pregnancies and deliveries are normal. I used to feel so lucky to be involved (and paid) to witness a MIRACLE. It was so utterly amazing that it never got old. So I totally understand the mind set of wanting to do things naturally and avoid the “medicalization” of pregnancy and delivery. BUT – having been involved with so many pregnancies and deliveries I have also seen tragedy strike. In these instances – for the mother and/or baby to survive or not suffer an injury – medical intervention was needed immediately (these circumstances are rare but once you have experienced them – it’s hard to forget). In these circumstances I was always so profoundly grateful that the woman and baby were in a setting where I could deliver appropriate care in a timely manner.

In my experience my patients tended to have one of three philosophies…

• The NATURALIST (ALTERNATIVE MEDICINE) – wants to honor the innate wisdom of the body and feels comfortable taking personal responsibility with gentle guidance from a professional. Example – These women tend to prefer few medical interventions and prefer a home birth.
• The COMPLIANT (TRADITIONAL MEDICINE) – wants a provider to make decisions for them and is not opposed to medical intervention – in fact they often ask for it. Example – This patient is fine with a technical approach to pregnancy and delivery in a hospital.
• The HYBRID (HOLDS HANDS WITH ALTERNATIVE AND TRADITIONAL MEDICINE) – truthfully in my practice this was the majority of my patients. Patients tend to find providers that “think like them”. So it’s no surprise that for my own health, it’s the philosophy I have adopted. I have always been interested in healthy habits and holistic approaches. After traditional MD training – early in my career, it became obvious to me that my patients achieved the best outcomes if I used a combination of traditional and alternative healthcare. I encouraged basic health habits, honoring the body’s wisdom and informed (not automatic) medical decisions. Example – My patients delivered in a hospital (in case they needed high tech interventions or even an epidural) but I supported their use of doulas, midwives, and low intervention. We made decisions by looking at the risks and benefits and did not blindly follow “standard of care”.

I respect women and their wisdom to make the right choices for themselves and their family. No one choice is the perfect choice. 👉🏻 The main point is to develop a plan – like most things in life (such as finances) your outcome will improve with proper planning. To help you I am including a link to a sample “birth plan” document to help you articulate your medical preferences.

This sample “Labor Preferences Plan” is one Mallory has previously shared and utilizes with her provider. The goal of this document is to simply & concisely state your medical preferences with any/all healthcare professionals who might be assisting you during labor & delivery. In most cases, L&D nurses are rotating on and off shift throughout your labor, your OB might not even be the Dr. who delivers your baby, things can move very quickly ++ sleep deprivation can make it hard for your support person to stay on top of articulating your desires (such as the golden hour after birth, or a delayed circumcision, for example).

How to utilize my “Labor Preferences” template (Dr. Smith’s Labor Preferences Document):

• Alter to align with your preferences (you will find general thought starters)
• Share with your OB around the 30 week mark, or earlier.
• Call your hospital/speak to the maternal care coordinator and ask that this information is added to your chart. That way all nurses who might tend to you should have visibility.
• Share with any support persons you plan to have present, like your partner.
• Upon arrival to the Labor & Delivery – double check/ask that the nurses have reviewed your plan. If not, share with them (bring a printed copy in your hospital bag just in case).

✨❤️ HEALTH YOURSELF ACTION: I think we are all free to have health PREFERENCES. Then I think it’s best to DISCUSS those with a well-informed provider. If it’s not your area of expertise – asking for guidance can help you further refine your philosophy. Once you arrive at your general philosophy it’s important to find a provider that you feel supports your decisions. FYI – Providers will always use their expertise and won’t always agree to all your requests (we don’t want to endanger you or the baby) but it is important to have your preferences/concerns taken seriously during this very important time of life.

2️⃣ UPGRADE YOUR HEALTH HABITS – FOR YOUR OWN HEALTH AND THE HEALTH OF YOUR BABY.

👉🏻 Example – We all know generally what foods are better for us and what chemicals we should avoid but we don’t always make it a priority. When trying to conceive and when you’re pregnant you will have extra motivation to help you GET REALLY CHOOSY about what you INVITE into your body. Take advantage of that extra motivation and really work to EXPAND YOUR HEALTH HABITS. It will not only improve your health but it will also improve the health of your baby and family. Women really are the family’s HEALTH CEO!

And WHAT NOT TO INVITE into your body? Unfortunately, we live in a toxic world. Anyone who has worked with me in the past or who has followed me on Mallory’s Instagram knows I am always talking about reducing your exposure to toxins – and no, I’m not here to be one of the many wellness influencers on the internet riding on fear mongering for virality- obviously. I like to take a more practical + educated approach to help women. BUT it is true environmental toxins can disrupt your health in many ways – including your hormonal health.

😩 Two alarming statistics point out the enormity of this problem. The average baby at birth already has 200 chemicals/pollutants in their umbilical cord blood (see article) and a new word has arisen – plasticenta (see article) – to indicate the presence of micro plastics in the placenta.

Since avoiding toxins is such a vast topic I have lovingly created a PDF with some helpful suggestions. Download now. This is not an individualized list or comprehensive list but you can use it to get started. eRemember – don’t get overwhelmed, start with what you can and keep adding habits when you can.

✨❤️ HEALTH YOURSELF ACTION – Optimal health requires keeping many substances out of the body! KEEP MY PDF – KEEPING A HEALTHY PERSONAL ENVIRONMENT – handy and get started. To individualize your recommendations, especially when pregnant, talk with your health provider.

👉🏻 Now let’s talk about what YOU SHOULD INVITE INTO your body when trying to conceive or pregnant. Reproducing is an energy intensive process that requires many nutrients. In general terms – the diet that is recommended during pregnancy is a varied whole food diet with all 3 macronutrients – protein, fats and carbohydrates. It is also full of micronutrients such as vitamins and minerals. Working with your provider you can assess the adequacy of your diet and identify any nutrient deficiencies. Example – Vegan diets tend to be low in protein and B vitamins.

Since it can be difficult to obtain everything you and your baby needs from your diet, most women also need to take supplements. Prenatal supplements are like an “insurance policy”. Your provider will direct you to their preferred brands and advise you on which supplements you need. Since most women need a Prenatal Multivitamin – I will share with you that, while there are many great brands on the market, I like the NEEDED brand of prenatal supplements (use code MAL20 for 20% off) – I reviewed NEEDED after they reached out and know they are careful to use bioavailable forms of their nutrients in adequate doses. They are mindful of absorption issues, they do quality testing of their ingredients and they are well versed in the unique nutritional needs of preconception and pregnancy (such as needing a bioavailable folic acid). Since their focus is on a woman’s reproductive years they have a full line of supplements for preconception, pregnancy and postpartum. Their STARTER PLAN – includes their prenatal vitamin and Omega 3 with an option of adding an iron supplement if needed. They also have powder forms of their prenatal and an “essential” form (fewer capsules required) for those women that are nauseous during pregnancy and have trouble taking supplements.

❤️✨ HEALTH YOURSELF ACTION – Discuss your nutrition with your health provider and make sure your nutrition is optimal. See if your provider has a preferred prenatal vitamin or recommends any additional supplements to you. Optimally you should improve your nutrition and optimize any deficiencies before you become pregnant (3 months before is a good time period) since some birth defects (such as neural tube defects) can occur very early in a pregnancy.

🤱🏻 MOVING ONTO POSTPARTUM…

✨ CONGRATULATIONS – you have delivered your baby! Now let’s talk about the POSTPARTUM PERIOD.

The 2 most common topics I am asked about concerning the postpartum period are #1 – breast feeding and formula questions. #2 – how to mitigate postpartum depression/overwhelm. So let’s dive in and cover these topics.

1️⃣ Breast Feeding and Formula Questions

A huge surprise for many women is that breast feeding is NOT an easy automatic process. Many quickly want to give up – especially when you add sleep deprivation to the picture. I don’t want to guilt trip any woman who does not breastfeed (there are many good reasons why a woman may choose not to breastfeed or tries to breastfeed and it just doesn’t work out). The bottom line is – if you do breast feed there are health benefits for both you and the baby. Examples – breastfeeding reduces ovarian and breast cancer risk for the mom (see article). For the baby – breastfeeding is generally more nutritious and improves their immune function. If you do choose to breastfeed I encourage learning about its ins and outs ahead of time so that you are more prepared for any challenges that may occur. Breastfeeding even for just the first few days after birth is beneficial but 6 months or longer is optimal to provide the most benefits. If you have difficulties, lactation specialists and trusted friends who have breastfed can be invaluable resources. I love that many pediatrician practices are now integrating lactation support into their clinics.

🍼 If you need/choose to use an infant formula of course discuss it with your pediatrician to see if they suggest a specific brand. But don’t worry I won’t leave you hanging – I will share with you my thoughts on what makes a “good” formula.

👉🏻 All formulas should contain the 3 macronutrients – a protein source, a fat source and a carbohydrate source.

• The protein source is usually cow’s milk but if allergies exist to cow’s milk – goat or soy can also be used. If your budget allows – I recommend organic formulas. If the formula is sourced from an animal it’s best if that animal is pasture raised and grassfed (the saying “you are what you eat” is also true for animals).
• The fat in formula is usually vegetable oil. To reduce the amount of vegetable oil used and to give a more well rounded fat profile I believe choosing a formula that uses full fat dairy (instead of no fat or low fat) is optimal.
• The carbohydrate source in formula is usually sugars found in cows milk (and breast milk) such as lactose. If a baby is found to have lactose intolerance of course there are other formulas available which use a different sugar. You mainly want to avoid the processed sugars such as corn syrup or sucrose (table sugar).

When Mallory stopped breastfeeding James she asked me to research infant formula. With all the above in mind – the formulas I recommended to her were Kendamil Organic and ByHeart. She ended up going with ByHeart with James – they produce here in the United States and tend to have fewer supply issues as there is not a barrier to import.

❤️✨ HEALTH YOURSELF ACTION – Nutrition for your baby is very important – they are developing and growing at a rapid pace! Plan ahead if you wish to breastfeed – seek education for the tips and tricks to success and find breast feeding support. In the event it is needed or you choose to forgo breastfeeding – investigate infant formula options ahead of time so that you can make a well-informed decision.

2️⃣ Mitigating Postpartum Depression/Overwhelm

Another huge surprise for women postpartum – Despite how cute and cuddly the baby is and the joy you feel as a mother – a lot of time and energy goes into taking care of a newborn. There is no way to adequately describe all the heroic things women accomplish in the postpartum – it’s just something you have to experience to understand. All this busyness can be overwhelming- especially since you just finished a nine month pregnancy and gave birth!!

👉🏻 On top of all the time and energy demands of your postpartum you will also be experiencing HORMONE SHIFTS. The highest hormone in pregnancy is progesterone which in general is a calming hormone. After the birth of the baby and placenta this hormone quickly declines and can leave women feeling anxious, depressed and overwhelmed. Most of the time “baby blues” are minor and short lived but for some women can escalate to full postpartum depression. To help avert this – DON’T FEEL GUILTY about asking for and receiving help. DOCTOR’s ORDERS – if someone offers – don’t decline! Lack of support is a risk factor for postpartum depression. Recruit your partner, your family, and your friends to help you. Help with meals, housework, errands, watching older children, watching the newborn while you sleep etc etc can all go a long way in helping you cope. If you don’t have support don’t push yourself. Rest whenever you get a chance and don’t take on additional responsibilities. If symptoms persist or become severe – ask your doctor for help. You may have thyroid issues or other medical conditions that can contribute to postpartum depression. In some cases hormones (like bioidentical progesterone) or medications are needed to reduce symptoms.

❤️✨ HEALTH YOURSELF ACTION – Ask for and accept help during the postpartum period. Consult with your doctor if you are not coping well.

That’s a Wrap ++ What to Expect Next Month!

💪🏻 WOMEN TRULY ARE AMAZING! – it has been such an honor and privilege to work with women over the years. As women navigate their reproductive years I see them GROW AND EXPAND as human beings. Pregnancy is not without its trials and tribulations – but KNOWLEDGE REALLY IS POWER. I hope this information will assist and support you during this exciting time of life.

Next month (if Mallory and the new baby don’t need my help too much) I plan on addressing the Menopause time frame in a woman’s life.

Until next month ❤️

Your Women’s Health Expert and Advocate

Dr. Brenda Smith M.D.

Dr. Brenda Smith, M.D. newsletter provides general health information for educational purposes only. The information in this newsletter is not to be used as a substitute for medical advice, can not diagnose or treat any health condition, and does not substitute for care from your own in person physician. Any questions regarding your own health should be addressed to your own primary care physician or other healthcare provider.