Choices Around Work

 This is the column where our readers can write in with their questions. We’ll field the questions to one or more experts in the subject and post the responses typically within 2 weeks. Write Us with Your Question!

Marcia Clark

Marcia Clark, Life and Legacy Coach

Q: I am 40 and pregnant with my first child who is due in March. I am having a hard time determining how much time to take off of work when baby comes. I love my work and am eligible for 3 months off. Being away from work for that long has both its pros and cons. How should I go about considering this important decision?

Our Expert who responded is Marcia Clark is a Legacy and Life Coach based in Austin, Texas and a Board Member of the Nonprofit Advanced Maternal Age Project.

A: First of all, congratulations! What a wonderful time in your life. Enjoy each moment!

How fortunate for you that you have a job you love. But I also know just because you love it doesn’t make the decision any easier…and possibly harder. Often times until we are faced with a situation it is difficult to know how we will react or what we really want. Some questions I have for you to consider are as follows:

  1. What are you most afraid of?
  2. What are you most excited about?
  3. When do you have to make the decision?
  4. What flexibility do you have, if any?
  5. What would it do for you to wait until the baby comes to make the final decision?
  6. How might you look at it differently after the baby comes?
  7. If you could create the ideal situation, what would it look like?

One of the tools I use with my clients is the Pain Gain Chart from where I received my coaches training, IPEC. It is a very helpful tool when trying to decide between two choices. I call it the dimensional “T” chart as it can offer much deeper insights. You can also continue to use it to “drill down” with each decision you make.

Here is how it works:

  1. On a piece of paper write across the top Pain and Gain.
  2. Then along the side write the two choices you are faced with. In your case, “Return to Work” and “Don’t Return to Work.” This will create four quadrants.
  3. Now begin within each quadrant and record the first thoughts that come to mind WITHOUT much reflection. i.e. the Pain of Returning to work in the top left quadrant, the Pain of Not Returning to Work in the lower left quadrant, continue with the Gain Sections.

See what enfolds for you. Often times you will discover things you had not thought of, one quadrant may emerge dominant, a clear decision may emerge, or a totally different solution may come to you.

Sometimes what blocks us is the pressure that we are making a decision that will have to last forever. Allow yourself the freedom to revisit your decision in the future. Life is about choice and endless possibilities. Whatever choice you make will be the right one for you! And that is what matters. Wishing you all the best!

Marcia Clark offers a complementary session in person or by phone to those who are interested in receiving life coaching and creating plans for their legacy. Contact her at

Selecting a Midwife

This is the column where our readers can write in with their questions. We’ll field the questions to one or more experts in the subject and post the responses typically within 2 weeks. Write Us with Your Question!

Kelly Hamade, CNM

Kelly Hamade, CNM

Q: I am 37 and considering having a midwife deliver my first child and would like to know how best to select one that is a good fit for me and my husband. What questions should I ask them?

Kelly Hamade is a Certified Nurse-Midwife with OBGYN-North and Natural Beginning Birth Center in Austin, Texas. She has 3 children, 2 born at home and 1 in the hospital. 

A: Choosing a health care provider during pregnancy is a big decision. As with most things, one size does not fit all and it is always a good idea to weigh your options carefully. When considering a midwife, you should be aware that there are different types of midwives and their scope of practice, experience and education may vary. Midwives also attend deliveries in a variety of settings including home, birth center and hospital. Many work independently while others are employed in a group practice.

As you interview prospective midwives, some general points to consider include her training, education and experience, options for location of delivery (home, birth center or hospital), if they share an office rotation or call schedule with other providers – can you meet the other providers, insurance coverage and fees. You might also ask about requirements for prenatal childbirth education, length and frequency of prenatal visits, pain-management options for delivery and follow-up care after delivery. Discuss your desires surrounding your pregnancy and childbirth experience and inquire about their philosophies.

Childbearing women who are under a midwife’s care generally have normal pregnancies without complications. Midwives are trained to recognize complications and variations of “normal” and often collaborate with other providers such as obstetricians, maternal-fetal specialists, chiropractors, massage therapists and lactation consultants. Talk with your prospective midwife about your risk factors. During the interview process, you may wish to disclose your age and any other concerns that may impact your pregnancy and labor. Inquire about any relative policies, protocols or guidelines that may affect your care. You may wish to research your options for genetic testing and find out which tests are offered, and which are recommended based on your age. Additionally, what other types of prenatal tests are offered or recommended based on your circumstances? Ask which conditions you are at increased risk for and how you will be screened. Find out the midwife’s policy in the event that a high-risk condition develops during your pregnancy, delivery or post-partum period. Are there other providers in their practice that are available to co-manage those complications or would you need to transfer to another group? Good luck and best wishes on your journey!




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Natural Labor Induction with Acupuncture

Sadie Minkoff

Sadie Minkoff L.Ac., FABORM

This is the column where our readers can write in with their questions. We’ll field the questions to one or more experts in the subject and post the responses typically within 2 weeks. Write Us with Your Question!

Q: I read that some women use of acupuncture to induce labor as an alternative to pitocin after 39 weeks of gestation. How does this work and is it safe?

Sadie Minkoff, L.Ac., FABORM and team at Sage Acupuncture in Austin specialize in Reproductive Acupuncture and Chinese Medicine. 

A: Acupuncture is often used as a safe and drug-free method for encouraging labor to commence. In fact, several studies have shown that acupuncture intervention is effective in facilitating a more efficient birth.

Labor induction, defined as when labor is “initiated artificially with drugs,” is actually a misnomer when used to describe how acupuncture works. Acupuncture supports the natural unfolding of the birthing process rather than an exogenous intervention forcing the body to do something it would not otherwise do.

  • In our experience, the best results come when acupuncture is used as a pre-birth treatment, preparing the body for labor gradually with one treatment a week starting at 36-37 weeks gestation.
  • This is the perfect time to reduce stress, and support energy and stamina for labor. Treatments are tailored to each individual woman’s body and pregnancy history, with a focus on ripening the cervix and positioning the baby optimally for labor.

As background, a 2004 observational study looked at the effect of pre-birth acupuncture (Medical acupuncture 2006 May; 17(3):17-20). Data on 169 women who received pre-birth acupuncture were compared to local population rates for gestation at onset of labor, incidence of medical induction, length of labor, use of analgesia and type of delivery:

  • In the acupuncture group comparing all caregivers (including midwives, OBs and specialists) the following were the overall statistics: 35% reduction in the number of inductions (for women having their first baby this was a 43% reduction) and a 31% reduction in the epidural rate.
  • When comparing midwifery only care, there was a 32% reduction in emergency caesarean delivery and a 9 % increase in normal vaginal births.
  • There was no statistical difference in the onset of early labor in those women receiving pre-birth acupuncture.

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Treating Allergies While Prergnant

Sadie Minkoff

Sadie Minkoff L.Ac., FABORM

This is the column where our readers can write in with their questions. We’ll field the questions to one or more experts in the subject and post the responses typically within 2 weeks. Write Us with Your Question!

Q: My nasal allergies are much worse now (at 4 months pregnant) than they were a year ago. What are some ways to feel better that won’t potentially harm me and my baby?

Sadie Minkoff, L.Ac., FABORM and team at Sage Acupuncture in Austin specialize in Reproductive Acupuncture and Chinese Medicine. 


This is a great question! We treat many pregnant women suffering from allergies. Not only because we live in Austin, the “allergy capital of the world” but also because when you are pregnant, your mucus production increases and your immune system is often more sensitive.

Here are 5 Tips to Help you Feel Better Naturally:

  1. Try a daily nasal wash like the Neti pot, to decrease sinus congestion and inflammation.
  2. Take a shower in the evening to wash away any residual pollen or dust from the day.
  3. Stay well hydrated and get as much rest as possible to keep your immune system strong.
  4. Reduce or eliminate dairy (goat dairy is less congesting than cow), as well as refined sugar, which contribute to inflammation and increased phlegm accumulation.
  5. Last but not least, acupuncture is a great support for allergies and for prevention of sinus infections. It is recommended for many pregnancy-related symptoms such as sciatica, insomnia, nausea, digestive upset, stress, fatigue, and yes, allergies.

Research has shown that acupuncture has a positive effect on the immune system as well as relieving the uncomfortable symptoms associated with allergies, including: sinus congestion, sneezing, runny nose, headaches, scratchy throat, and fatigue.

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Healthy Eating During Pregnancy

This is the column where our readers can write in with their questions. We’ll field the questions to one or more experts in the subject and post the responses typically within 2 weeks. Write Us with Your Question!

Margaret Connor

Margaret Connor, MPH, CHC

Q: I’ve always had a pretty healthy diet but now that I am pregnant, what vitamins, minerals and other nutrients are critical to include for optimal health for me and my baby?

Response from Margaret Connor, MPH, CHC, The Wellness Pantry

A: It sounds like you have already helped yourself and your baby by eating healthy before your pregnancy began, which is terrific. Now let’s examine how our metabolic needs do increase during pregnancy. The following vitamins and minerals play a special role in your health and that of your child’s during pregnancy (and often postpartum as well). One exciting detail to consider is that the absorption of nutrients across our intestinal barrier typically increases during pregnancy, so eating good sources of these vitamins and minerals will go a long way towards keeping you equipped with the necessary nutrients.

FOLATE – You’ve probably heard your OB mention this as a valuable supplement that you might have been taking even before you became pregnant. The evidence that folate reduces the risk of neural tube defects is so compelling that the U.S. started fortifying grains with folate in 1998. The current recommendation is for women with child-bearing potential to be taking 400 micrograms/day and for pregnant women to take 600 micrograms/day. Good dietary sources of folate include broccoli, spinach, lentils and other beans. FUN FACT: Did you know that folate is actually Vitamin B9?

IRON – This is the most common deficiency we see in pregnancy and it typically appears in the second or third trimester. During the first trimester, your body’s increased metabolic demands for iron are balanced out by the fact that you are no longer menstruating each month. However, your body’s demands for iron will increase during your pregnancy and as such, your doctor will likely be keeping a close eye on your levels. On average, 13-40 mg/day of iron supplementation is recommended. Most prenatal vitamins (which we actually take during pregnancy) contain about 30mg. If you are found to be iron-deficient, or anemic, your doctor will place you on a higher dose and recommend that you continue supplementation postpartum. The best dietary sources of iron are read meat, poultry, fortified cereals and beans. Iron is best absorbed from food when it is eaten with foods containing Vitamin C.

CALCIUM –  Calcium is required for your baby to grow healthy bones and teeth. Some studies have also shown  that calcium supplementation during pregnancy can lower your risk for pregnancy-induced hypertension and preterm delivery due to preeclampsia. It is recommended that pregnant mamas get 1000mg of calcium per day. The average daily intake for most women is about half that amount. As a result, most prenatal vitamins provide calcium supplementation. Good dietary sources of calcium include dairy products, sardines, collard greens, sesame seeds and tofu. To be honest, with the exception of dairy (which I don’t tolerate) that can be a tough list of foods to find palatable during pregnancy. Just do what you can.

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Preparing Your Body for Fertility

Sadie Minkoff

Sadie Minkoff L.Ac., FABORM

If you are reading this post, it is probably because you are preparing to grow your family in your thirties or early forties. In spite of what you may have heard, this is a great time in life to become a parent and more and more people are choosing to do so. In fact there is some evidence that, although it may not be as easy to conceive as for our younger counterparts, women of advanced maternal age may have more success than was originally thought. So how can you optimize your chances? Chinese Medicine is one of the best ways to support fertility.

Often women hear about positive experiences with Chinese Medicine from their friends and family, from a support group, or from their doctors.

Treatment with Chinese Medicine involves a combination of receiving acupuncture, shifting lifestyle habits, and learning what you can do to optimize the potential to conceive and carry a healthy baby.

Why Acupuncture?

Acupuncture techniques have been proven to regulate the hypothalamic-pituitary-ovarian axis. This may improve the health of ovaries and their hormone production, a concern for women of advanced maternal age. It may stimulate blood flow to the uterus (by inhibiting uterine central sympathetic nerve activity), increase serotonin, and decrease stress. Often your practitioner will also prescribe medicinal herbs to facilitate this process. The combination of acupuncture and herbs has a synergistic effect.

The idea of changing our habits may seem daunting, but things can shift in a remarkable way with some relatively simple changes. Everyone knows that eating better makes us healthier, but there are some specific things that we can do to optimize our health and fertility. Focusing on changing one’s diet is part of the equation.

Chinese Medicine focuses on paying attention to the entire mind, body and spirit as a whole. Consider the following:

  • What makes you happy?
  • What is fun for you to do?
  • Tap into your creativity.
  • Take walks in nature.
  • Move your body. Exercise releases endorphins which help to keep a more positive focus when life gets difficult.
  • Do something regularly to take care of yourself and give yourself the attention that you deserve. That could mean receiving a massage, going dancing, journaling, or painting. Meditation, yoga, and/or tai qi are avenues for stress and anxiety reduction, as well as for the simple act of being with oneself.

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Exercise During Pregnancy

We have begun a new column where our readers can write in with their questions. We’ll field the questions to one or more experts in the subject and post the responses typically within 2 weeks. Write Us with Your Question!

Tatum and Her Dog Griz

Tatum and Her Dog Griz


Our expert for this question below is Tatum Rebelle, an experienced fitness professional and owner of  Total Mommy Fitness.  Read more about Tatum’s work here, including her online prenatal fitness program.

 Q: I have been a runner for the past 5 years and just learned that I am pregnant. Do I have to give up running?

A:  If you were a runner before you were pregnant there is no reason that you cannot continue as long as it feels comfortable and you have the okay from your doctor. This is a very important time to listen to your body and do not push it to your pre-pregnancy intensity.

Q: I love weightlifting and find it empowering. What are the common restrictions about this while pregnant? I want to be safe but also stay in shape for when my baby arrives.

A:  Weightlifting is safe and very beneficial during pregnancy. You can continue your pre-pregnancy routine as long as it feels comfortable and your doctor has cleared you for exercise. If you were not lifting weights before pregnancy you can begin a routine that feels comfortable. Pregnancy is not a time for powerlifting and explosive movements, but a full body, moderate intensity program has many benefits for you and your baby.

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7 More Tips on Fighting Fatigue

Fatigue Section of  Better Late than Never BabySerena Kirby, a professional writer and AMA mom from Western Australia contacted us recently. Her new book called Better Late than Never Baby includes information and suggestions not found in other sources for expectant moms over age 35. We’ll share excerpts from her book with our audience and let you how you can get your own copy.

Serena Kirby

Serena Kirby, Writer and AMA Mom

7 More Tips on Fighting Fatigue (Part 2, a condensed excerpt from Better Late Than Never Baby by Serena Kirby ©2013)

  #1 Eat Up, Eat Well Input always affects output so good nutrition is important in keeping up your energy levels and battling fatigue. If you’re breastfeeding, nutrition carries an even greater importance, and it’s a good idea to eat as if you’re still pregnant.  Drink, drink, drink lots of fluids – at least 10 cups a day when pregnant and at least 13 cups when breastfeeding. You also need good nutrition and energy-generating foods to help your physical recovery from the birthing process (natural or caesarean) and to boost your immune system. It’s particularly important to make sure you’re getting enough iron in your diet so you don’t become anemic (one of the most common fatigue-causing medical conditions for new moms).  Your daily iron demand increases nearly 10-fold from the start of your pregnancy, but research shows that less than 25 per cent of women start their pregnancies with enough stored iron to meet their increasing nutritional needs. As such, by the end of the pregnancy, a large number of women are iron depleted if not anemic. If left untreated, the condition continues and often worsens in the weeks after giving birth, and the result is overwhelming fatigue. If you can’t get all the iron and other goodies you need in your diet, talk to your doctor or midwife about vitamin and mineral supplements.

#2 Hormones and Nutrition
If you’re an over-forty mom and feeling continually tired and moody, your fatigue may be being worsened by the prelude to menopause – perimenopause. Remember that during this time your body and your hormone levels are changing (as if puberty, pregnancy and breastfeeding wasn’t enough for one lifetime). To find out if perimenopause is contributing to your fatigue, speak to your doctor about having a blood test to check your hormone levels, but know that they are not completely accurate in showing smaller, subtle changes.  A more advanced and accurate method is the saliva sample test but not all doctors use it so you’ll need to call around to find one that does.

#3 Exercise
As strange as it sounds exercise is actually an excellent way of beating fatigue. You may be thinking, “Hell, I don’t have enough energy to get out of bed let alone run around the block”, but the truth is exercise has been proven to be highly effective in reducing fatigue. Whilst pushing the stroller around the block is good for your physical well being, many mothers suggest that exercising without your baby has the added bonus of providing a chance to truly switch off and be off duty.  You can let your mind wander without being disrupted by a child demanding your attention (yet again). Plan to exercise three to four times a week, preferably in the morning when you have more energy, and block out some time for exercise without your child. What to do with the baby? Most gyms have a childcare facility or ask a relative or friend to babysit.  Or go out early before your partner goes to work (you’re up anyway!).
#4 Conserving Energy
On the flip side of using energy to exercise is the saving of energy around the home.  Organize your home with items and systems that make life easier. Think of the home – especially the nursery – as a workplace (it’s where you’ll do most of your work in the first few months anyway) and spend time making sure you have everything you need exactly where you need it. Review and update your needs every few weeks because, as the baby grows so to will your routines and needs.

Doulas in the Hospital

We have begun a new column where our readers can write in with their questions. We’ll field the questions to one or more experts in the subject and post the responses typically within 2 weeks. Write Us with Your Question!

Shelley Scotka

Shelley Scotka, Birth Doula and Childbirth Educator

Our expert for this question below is Shelley Scotka, an experienced doula and childbirth instructor in Austin, Texas.  Shelley is a mom of two and has been helping women and their partners since 1995. Read more about Shelley here.

Q: How does a doula work with my physician and the nurses in the hospital where I am delivering?

A:  A birth doula works alongside medical care providers but does not provide medical care. Instead, a doula provides emotional, physical and informational support for the laboring woman and her partner. Medical care providers, including your doctor and labor nurses, are really “lifeguards” who oversee the safety of the mother and baby. A doula is there to offer continuous support, to make sure the woman feels cared for, safe and respected. A doula listens and reassures, offers suggestions for positioning and comfort, uses touch and massage, and encourages communication between a woman and her medical care providers. After the baby is born, a doula stays in touch with the family and offers additional support with breastfeeding, newborn care, and making sure the family transitions well during postpartum.


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5 Suggestions for Fighting Fatigue

Better Late Than Never BabySerena Kirby, a professional writer and AMA mom from Western Australia contacted us recently. Her new book called Better Late than Never Baby includes information and suggestions not found in other sources for expectant moms over age 35. We’ll share excerpts from her book with our audience and letyou how you can get your own copy.

Serena Kirby

Serena Kirby, Writer and AMA Mom

5 Suggestions for Fighting Fatigue (Part 1, a condensed excerpt from Better Late Than Never Baby by Serena Kirby ©2013) 

#1: Get Support

Countless experts state that support is essential in beating tiredness and fatigue.  But as the issue of fatigue is often downplayed and overlooked, the support a new mother receives (from her partner and others) may not actually be as adequate or as long lasting as may be required.

As today’s family unit has become increasingly smaller, more isolated (physically and socially) from extended family and more self-sufficient, the ready-made support network found in many other countries is lacking.  The result is that many older mothers have little or no support base on which to draw and she is left to primarily fend for herself.

This is a far cry from the support available in many Eastern and European countries where there is a tight extended family and a cultural understanding and expectation of pitching in and helping when a new baby arrives. The old African proverb that ‘it takes a village to raise a child’ is still alive and well in many countries.

In China, for example, there is a support practice known as zuo yuzi, which involves a month of confinement after the baby is born. During this highly protective period the new mother is cloistered at home and given high levels of support from relatives. The mother is not allowed to work and is discouraged from getting out of bed (now you’re talking!) as any energy-sapping activity, other than looking after herself and her baby, is considered bad for her health and could in fact do her unthinkable harm in future years. A form of zuo yuzi is adopted in many other Asian countries and while experts say[i] our western culture would make it difficult to emulate, they agree the idea holds definite merit and benefits.

In the absence of zuo yuzi, good advice comes from Australian researcher Carol McVeigh who has argued that women really do need to address the issue of support, where and how to get it before the baby is born, and that support should be considered part of the childbirth education process.[ii] She goes further to suggest that ‘actively enlisting’ help is a skill women should be taught while pregnant.

As such, why not develop a list (then double it) of the support you think you may need and who is available to help. Talk to each person about the issue of fatigue, and the importance of support, and come to an agreement on how and when they can provide assistance. Be specific (write it down if you have to) otherwise all your planning is likely to go out the window (quickly followed by your energy) when the baby arrives. Don’t forget to think past the first six weeks post birth – remember fatigue has a nasty habit of increasing, rather than reducing, over time.

#2 Offers of Help

Change the way you think about accepting help and even practice saying ‘yes’ in front of the mirror. Make it a personal goal to say ‘yes’ whenever the word help is mentioned.

#3 Put ‘Self Care’ on the list

Being a mother is a relentless job and many days during the early months will feel like Groundhog Day. The repetition of feeding, changing, holding and soothing your baby dulls your senses and numbs your mind – all of which fosters fatigue.   Finding time for yourself is so rare that it’s no wonder you lose track of who you are – let alone remember what day it is.

It is also a mother’s instinct to put the care of her baby and family before her own, but many studies show that this is often to her own detriment. Taking regular time out and time away from your baby is important. It may be coffee with a friend, a walk, reading a book, enjoying some pampering or simply resting and doing nothing at all. Being off duty helps relieve stress, breaks the repetition of Groundhog Day and gives you a sense of self. It lets your body and mind rejuvenate and rest.

Remember to think of ‘self-care’ as being an essential item, not as something you’ll do if and when you have time.  And, by making a standing booking to take time for self care (at least two to three times a week even if you’re working outside the home) you won’t have to repeatedly ask your partner, or someone else, to care for the baby. Everyone will know that there are set times on certain days when you are not available to be with the baby.

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