More First Trimester Screening Options

Many women who will deliver a child after the age of 35 opt to have prenatal testing during the first trimester of pregnancy due to the increased risk of genetic abnormalities that come with older eggs.  Until 2012 the most common first trimester screens have been the ultrasound test for fetal nuchal translucency and chorionic villus sampling (CVS). Nuchal translucency screening uses an ultrasound test to examine the area at the back of the fetal neck for increased fluid. CVS is a procedure performed by a maternal and fetal health specialist physician who removes fetal cells for examination using a guided ultrasound.

Non-invasive tests for chromosomal disorders that examine small amounts of DNA from the fetus in the blood of pregnant women and can help diagnose a few genetic disorders starting late in the first trimester started becoming available throughout the U.S. in 2012.

Ob-gyns say the blood tests can pick up about 98 percent of Down syndrome cases with a false positive rate of 0.5 percent – meaning one in 200 babies without Down syndrome will mistakenly get a positive result. For all women who screen positive for Down syndrome or trisomy 13 or 18, American College of Obstetrics and Gynecology recommends referral to a genetic counselor as well as more invasive follow-up testing, such as with CVS or amniocentesis.

The main advantages of the blood tests is they often all but rule out Down syndrome and make more invasive testing unnecessary, according to Dr. Diana Bianchi, head of the Mother Infant Research Institute at Tufts Medical Center in Boston. “The invasive procedures have some very small, but real risks of miscarriage,” said Bianchi, who is also on the clinical advisory board of Verinata Health, which offers a version of the DNA test.

Now genetic testing companies are developing more uses for the blood tests, such as to identify gender and other genetic disorders like Turner syndrome. Running the blood tests now costs $1,200 to $2,700 each, according to Bianchi, but the majority of that is typically covered by insurance.

The Trend Continues – More Older Mothers in 2011

The recent report by the Centers for Disease Control and Prevention is a first glimpse at 2011 birth certificate data from state health departments. (More analysis comes later but officials don’t expect the numbers to change much.)

“…birth rates held steady for women in their early 30s, and rose for moms ages 35 and older.” Many others had declining birth rates in the down economy.
“Early data for 2012 is not yet available, and it’s too soon to guess whether the birth decline will change,” said the CDC’s Stephanie Ventura, one of the study’s authors.

Other Highlights of the CDC Report include:

  • The birth rate for single women fell for the third straight year, dropping by 3 percent from 2010 to 2011. The birth rate for married women, however, rose 1 percent. In most cases, married women are older and more financially secure.
  • The birth rate for Hispanic women dropped a whopping 6 percent. But it declined only 2 percent for black women, stayed the same for whites and actually rose a bit for Asian-American and Pacific Islanders.
  • Birth rates fell again for women in their early 20s, down 5 percent from 2010 – the lowest mark for women in that age group since 1940, when comprehensive national birth records were first compiled. For women in their late 20s, birth rates fell 1 percent.
  • But birth rates held steady for women in their early 30s, and rose for moms ages 35 and older. Experts say that’s not surprising: Older women generally have better jobs or financial security, and are more sensitive to the ticking away of their biological clocks.
  • Birth rates for teen moms have been falling since 1991 and hit another historic low. The number of teen births last year – about 330,000 – was the fewest in one year since 1946. The teen birth rate fell 8 percent, and at 31 per 1,000 girls ages 15 through 19 was the lowest recorded in more than seven decades.

Post-Pregnancy Exercise Podcast: how to lose the baby weight

Originally posted on Total Mommy Fitness by Tatum Rebelle. Thanks for sharing your wisdom and experience with our audience!

Learn how to start exercising and lose weight after your baby is born!podcast icon 300x273 Post Pregnancy Exercise: how to lose the baby weight

  • When is it okay to begin a fitness program?
  • What exercises can I do right away?
  • How many calories do I need to breastfeed?
  • What if I am too exhausted to get to the gym?

Hear the answers to these questions and more in the Total Mommy Fitness podcast!

Interviewing an Obstetrician

This was originally posted on June 8, 2012 and is now revised to include even more questions. Thank you to Robbie Davis-Floyd, Ph.D., medical/cultural anthropologist for adding more depth to this important topic.

Earlier in my career I moved four times, from state to state for new and exciting roles. That meant pulling up roots and transplanting, including finding new doctors. Since I am healthy person who values preventative healthcare, having a family doctor, allergist, and OB/Gyn was (and still is) very important. I picked names and biographies from insurance carrier directories to start and then sought referrals if I found a physician who I thought was very competent and a good listener, I asked who they would select for their own healthcare.

That was the case when I moved to Austin. My family doctor and now friend Michelle Markely referred me to specialist doctors in her large medical practice. For 15 years, I have trusted her opinion. Unfortunately, after my experience with Dr. B. in 2007 (mentioned in this earlier story and who is no longer delivering babies), I set out to do things differently – for my new OB/Gyn, as well as for the pediatrician for my children.

I elected to interview new physicians to be sure they were a good fit for me and my family.

Here’s a list of potential questions that can be asked of a prospective obstetrician, a medical doctor with a specialty in prenatal care and delivering babies.

  • As with any good interview seek to ask open-ended questions, to help elicit how the obstetrician feels, and engage in a discussion rather than ‘yes’ or ‘no’ answers.

“What you are looking for is not the “right answers,” but instead those that match your intentions and belief systems.”



Here are 20 possible questions to ask. You may think of more as they relate to your own health history or concerns.

  1. Why did you choose your profession?
  2. What are your philosophies and beliefs about childbirth?
  3. Do you have children of your own and how were they delivered?
  4. How do you believe my AMA status affects my pregnancy and how will that inform your actions and interactions with me?
  5. Where do you deliver babies?
  6. What are your standing orders for hospital deliveries (given routinely to nurses on duty)?
  7. Have your worked with doulas in delivery and what has been your experience?
  8. What do you think about prepared birth plans?
  9. Do you recommend or support the use of alternative medicine such as acupuncture or chiropractic care during pregnancy, and under what scenarios?
  10. What are your thoughts about pain relief during labor?
  11. Do you enjoy attending natural childbirths?
  12. From what point do you calculate my baby’s due date?
  13. At what point do you feel induction of labor should be considered?
  14. How often do you induce? In what percentage of births?
  15. If my pregnancy should go beyond 40 weeks, would you check my amniotic fluid level?
  16. If complications arise with my pregnancy, how will you inform me and will you present choices for my care?
  17. How do you feel about breech birth? What course do you typically follow?
  18. In what situations will you recommend a caesarean section?
  19. What is your primip (first time delivery) c-section rate?
  20. How do you typically handle episiotomies? When would you perform one?
-Sharon Munroe

Image courtesy of

FAQs from the Lactation Consultant

Photo courtesy of Jennifer Mayne Photography

Q & A with Linda Hill, Lactation Consultant, Supporting Moms with Breastfeeding

Q: What advice do you have for a woman who is planning to nurse their baby?

A:  Take a breastfeeding class before delivering if you can so that you know what to look for in a good latch.  It is important to know when to ask for help!  It is important to know how to read the signs to know if your baby is getting enough!  Also, read a book about it!  I like The Nursing Mother’s Companion by Kathleen Huggins.  The electronic version of Baby 411 is good too as there are video clips you can watch that are helpful.  I like the book too.  And, lastly, have support lined up!  Your partner being the best support person, but it is also helpful to have some girlfriends who breastfed or are currently breastfeeding.  If you don’t have any of those – then find an Attachment Parenting group or a La Leche League group.

Q: What is the #1 nursing issue you see when women come to see you and what other issues do you see?

A:  The #1 reason for a visit to a lactation consultant (LC) is nipple soreness. It is normal to have nipple tenderness, especially in the beginning, but you shouldn’t have cracks or scabs. If you have those, something isn’t quite right. A LC can often tell what is going on just by how the nipple wound looks. When moms have linear scabs on their nipple, it is usually a positional problem. When the entire nipple is scabbed, it is commonly a tongue issue with the baby (e.g., tongue-tie, tongue sucking, or bunching up the tongue in the back of the mouth) or mom may have flat or inverted nipples.

  • All of these “problems” have “solutions”, some taking longer than others to fix. Lactation consultants have many tools to help moms thru these “problems”. There are nipple shields, supplemental nursing systems, pillows, nipple creams, gel pads, syringe feeding, pumping, bottle feeding, finger feeding, suck training and etc.

The #2 reason is perceived or actual low milk supply.

Don’t you wish you could hold your breast up to the light and see how full or how empty it was!

Though it is true that almost ALL moms can produce milk, not all moms can produce enough. And unfortunately, we can’t predict who will be able to and who wont, so you just try your hardest and see how things work out!

  • There are some “red flags” that lactation consultants cue into: no breasts growth or changes during pregnancy, hormonal issues that may have made it difficult to get pregnant, thyroid problems, diabetic moms, bariatric surgery, obesity, PCOS, breast surgery, chest trauma/surgery, advanced maternal age, abnormally shaped breasts, and large blood loss with delivery.
  • Just because a mom has one or more of these doesn’t mean she is going to have problems … but they often warrant a watch!

    Parents should take a breastfeeding class before their baby is born so that they can know how to tell if their baby is getting enough and know when to seek the help of their doctor or LC.
  • Again, LC’s have many tools to help moms increase their supply! There are improved techniques, hospital grade pumps, and herbs, to name a few.

[Read more…]

Are You Ready to Consider Adoption?

Source: via Leisha on Pinterest

By Jess Pedersen. Originally published on the blog for Without Child, The Advanced Maternal Age Project brings some important considerations and questions to ask yourself:

Giving up the dream to have a biological child can be intense.

For most people it is an incredibly difficult decision for many reasons:

  • After years of trying, how do you know when to say it’s time to stop?
  • Never having the opportunity to experience pregnancy and childbirth can be heartbreaking.
  • You may feel anger and resentment toward your body for not working the way you thought it should.
  • You may feel attached to your genetics, so not having a child that resembles you or your spouse may be an issue for you.
  • You may feel pressure from family members to keep trying even though you’ve reached the end of your baby-making rope.
  • Depending upon how you choose to form your family, you may have to endure insensitive comments from friends who haven’t been in your shoes.
  • Grief often accompanies the choice to stop trying to conceive, so be kind and patient with yourself and your spouse as you transition to another path toward parenthood.

When you know you’re ready to begin the journey.

Never fear…there are a few things that you can do to make the transition to adoption easier:

  • Connect with friends who have adopted and ask them a million questions, they won’t mind!
  • Start researching the adoption process by checking out different agencies online.
  • Include local agencies in your search; you will need one for the homestudy portion of the process.
  • Request information packets from the agencies that look good to you.
  • Determine your preference regarding domestic versus international adoption.
  • Find adoption support groups in your area (local agencies are great resources for these groups).
  • Keep a journal or, if you’re the sharing type, blog about the process to keep friends and family involved.
  • Stay connected with your spouse regarding your hopes and dreams for parenthood!

If you are reading this and contemplating adoption as your next step toward parenthood, perhaps one day you will look into the face of a child that looks nothing like you and hear the word, “Mama” or “Dada”, and feel like the luckiest person on the face of the earth.

Jess Pedersen is a health coach, amateur guitarist, lover of words, part-time marketing guru, and addict of real wholesome tasty food.She also loves to help all women find and nourish their inner Mama, is a contributor to this website and writes for her own, She is on Facebook, and on Twitter via @BeMamaBeWell.

7 Things to Do to Beat Fatigue During Pregnancy

By Tatum Rebelle, Fitness Expert and Owner of Total Mommy Fitness

pregnancyfatigue 7 Ways to Beat Fatigue During PregnancyPregnancy is an amazing time full of excitement and anticipation, and it is also a time for morning sickness, discomfort, stress, and extreme fatigue! Luckily, most of the moms you talk to will say that all of the unpleasant symptoms were well worth it when they got to hold their new baby for the first time.

The fatigue during pregnancy can be debilitating for many women. It is usually worst during the first trimester, but can sometimes stay into the second and third. Feeling tired may be inevitable for some, but there are several things that can be done to give you more energy and lessen the negative side effects of pregnancy.

1. Take a walk — sometimes just getting your blood flowing for a few minutes is all that you need to feel revitalized. If you can go outside in fresh air and sunshine that is even better!

2. Adjust your meals — eating a big meal makes people tired even when they are not pregnant! Stick to smaller, more frequent meals throughout the day to keep your energy steady.

3. Eat breakfast — skipping breakfast is one of the quickest ways to mess with your energy and hunger. Setting a good tone with breakfast will carry over to the rest of the day.

4. Listen to Popeye — remember him? Eat your spinach! Pregnant women need to make sure they are getting plenty of nutrients, especially iron. Don’t forget your prenatal vitamin too!

5. Nap — if you need rest, sleep. Your body is doing a lot of hard work and would appreciate a break. Take advantage while you still have time to sleep before your baby arrives.

6. Hydrate –  sometimes we reach for the sugary snack, simple carbs, or caffeine to wake us up when we really just need is a tall glass of water.

7. Exercise — besides walking, try to get into a consistent routine that includes something like resistance training, yoga, swimming, etc. Keeping your endurance up and your muscles strong will help battle fatigue.

You may be one of the lucky ones who does not suffer from fatigue during pregnancy, but if you are like most women and find yourself fighting to stay awake, try these tips. Please let me know if you have any others that helped you while you were pregnant!

Tatum is the Founder of Total Mommy Fitness. Pre and postnatal fitness and nutrition expert. Training available in Austin, and online.


A Different Type of Infertility

Source: via Heather on Pinterest

There’s a term that many of us have never heard of and  it affects women ages 35+ more than younger women.

It’s Secondary Infertility.

According to Iris Waichler, MSW, LCSW, in her book Riding the Infertility Roller Coaster, Secondary Infertility is an important and often overlooked part of the story of infertility. This occurs when people have been successful in having children and then are unable to conceive another child. (Women over 35 who have been trying for 6 months who are unable to conceive again may receive this designation). This can happen for a variety of reasons and can also be an incredibly painful experience. Friends and family may not respond in an empathetic way because they know there are already children, and even medical professionals can even downplay the problem. (Editor Sharon saw this with her first OB, Dr. B.)

Often there is a lack of understanding about how difficult it is to lose the ability to have children. But the feelings of loss, sadness, and grief can be as intense as the feelings of those people who who are unable to conceive any children, according to Iris. Support groups and therapists fill an important need for many couples.

According to RESOLVE, the National Infertility Organization, there are some important considerations: the couple must focus on the desire to parent a second child and the time, energy, and finances involved in pursuing medical treatment or alternatives such as adoption. These conditions must be weighed with the needs of the existing child(ren) in mind.



Healthier Eating During Pregnancy

By Margaret Connor, MPH, Founder of The Wellness Pantry

I am a nutritional counselor and so of course, always a healthy eater. Right?  Well so I thought. When I got pregnant, everything turned on its head. In the months leading up to my first pregnancy, homemade tofu and steamed broccoli was literally my favorite choice for dinner.

So it came as quite a disappointment to me, when the ONLY foods I craved during my first trimester were bacon and French fries. And for the first time in a long time, donuts started looking fantastic to me. This wasn’t the result of years of denying myself indulgences. I ate treats, they were just healthy or homemade versions.  Needless to say, my husband -whose first choice was not tofu and broccoli- was delighted.

My eating habits


had to change. I had to find a happy medium between my cravings and what I knew, nutritionally, about feeding my growing baby. Honestly, I don’t think I ever ate broccoli during my pregnancy but I discovered other healthy things that worked – like a new love affair with grapes and fresh citrus marinades that made everything taste great.

I followed my first pregnancy with two more and during the last, I proudly wore my advanced maternal age (AMA) badge to each doctor’s visit. I have learned much along the way and my last transition to eating for two went far smoother than the first. So take the time to examine what might feel like a new set of taste buds. No matter what your cravings, there are healthy options out there with flavors and scents you can come to love.


I cannot emphasize enough how important protein and fiber are during pregnancy. These are the two foods that will help you keep energy levels and blood sugar stable. Foods containing fiber and protein take a bit longer to digest in your stomach, which is often a successful strategy while battling morning sickness. Often, having a little food in your stomach can reduce feelings of nausea.

Good sources of fa


t are also essential. Like fiber and protein, fat takes longer to digest and slows down the absorption of sugar into your blood stream. This provides with you a slow trickle of energy throughout your day instead of the ups and downs common after eating foods high in carbohydrates but low in protein, fiber or fat. More mature moms can be extra sensitive to these ups and downs, and more likely to feel shaky, dizzy or nauseous with rapid changes in blood sugar.


Your baby needs good fats to grow a healthy brain. My favorite fats to recommend during pregnancy come from oils, lean meats, nuts (not peanuts), nutbutters, eggs and avocados. Pregnant or not, I favor olive, coconut, macadamia and walnut oils over others.

Fatty fish is another great source of the great omega 3 fatty acids that you’re reading about. DHA and EPA are the brain-building and immune-boosting elements in omega 3 fatty acids and fish like salmon, cod and anchovies are the best source. As a mercury precaution, remember to limit your intake of fish to one or two servings per week. Check this website for

your favorite fish(es) and whether they’re safe to eat during pregnancy.

Do avoid any partially-hydrogenated fats which are known to lower good cholesterol and increase bad cholesterol, increasing your risk of cardiovascular disease. Interesterified fat is a new hydrogenated product on the market with similar ill effects on cardiovascular heath, so keep an eye out.

Also work in nutrient-dense foods. These are the foods that will complement the prenatal vitamins and supplements recommended to you by your OB.

  • Fruits aNutrient-Dense Smoothiend vegetables tend be the best bang for your nutrition buck, so aim for a wide variety.
  • Our bodies are designed to visit the world of fruits and veggies like a buffet: sampling different colors, flavors and textures.
  • Smoothies are a great, painless way to integrate fruits and vegetables into your daily diet, especially if you wake up feeling off but need something to eat first thing. Here is my basic smoothie recipe that you can tweak as you like.  Also if nausea is something greeting you each morning, try to add ginger into the mix of ingredients.

A single superfood ? Total myth. It is the variation of vitamins and minerals in different nutrient-dense foods that gives us what we need for the optimal health of our growing bodies and babies.


I am adamant with my clients about cutting back on added sugars.

Since as AMA moms we are more at risk for gestational diabetes than our younger pregnant peers, it makes sense to be wary of sneaky sugars

. Here are some less obvious ways you will see added sugars in the ingredients list of your food:


–              Cornstarch-              Glucose-              Maltose-              Maltodextrin-              Dextrose-              Crystalline Fructose-              Sorbitol-              Cane sugar-              Beet sugar –              Mannitol-              Corn syrup solids-              HFCS-              Brown rice syrup-              Honey-              Moalsses-              Maple syrup-              Agave-              Palm sugar

A good rule of thumb? Anything that has 15-20 g of added sugars per serving should be considered a dessert . As mentioned earlier, I’m not anti-dessert, but we need to be informed. The worst added-sugar offenders are drinkable. (Think: sodas, Starbucks coffee drinks and Odwalla smoothies.)

As you have likely heard, AMA moms are also at greater risk for hypertension. Your doctor will be keeping a close eye on you to gauge your blood pressure levels throughout your pregnancy. Your sodium intake should always be below 2300mg. Reducing your sodium intake much lower than this will, unfortunately, not prevent the onset of hypertension during pregnancy.


While the idea of eating for two is as common as they come, the notion is a false one. I can remember first hearing this and immediately feeling the pressure to feed two life-sized versions of myself each day. But there was no need for my panic. On average, you need 300 additional calories per day to keep yourself and your baby growing at a healthy rate. This average does not apply to everyone, since weight gain during pregnancy is dependent upon your prepregnancy weight. Here are some helpful guidelines for weight gain during pregnancy:

  • With a prepregnancy BMI between 18.5 and 25, which is considered normal, you should expect a weight gain during your pregnancy of 25-35 pounds.
  • If your BMI was less than 18.5, you would want to gain 28-40 pounds during your pregnancy.
  • A BMI greater than 25 has you gaining less during pregnancy, so aim for 15-25 pounds. For a BMI over 30, you would be expected to limit your pregnancy weight gain to 15 pounds.

Looking to keep eating healthy during pregnancy and beyond? There are many resources, including The Wellness Pantry founded by Margaret Connor and currently helping families in Greater Austin with personal counseling and workshops.  See her on Facebook too. Margaret holds a masters in public health, is nutritional counselor, a Certified Health Coach,  and is mother of three children, two of whom require special diets.

Sandwich Savings & Planning

sandwich generationMany of us have read about the sandwich generation of adults supporting their aging parents and children at the same time. There are financial concerns, in addition to the need to provide care for their two families. Many of us might feel the same type of squeeze but it’s related to how closely our retirement age will coincide with our children’s college years and the financial commitments of both. (We’ve all read the headlines about young people graduating from college with huge amounts of student loan debt.)

While not my career, financial planning has been an interest of mine for a long time, so I’ll share some thoughts with other Advanced Maternal Age moms.

Original Plan

As a recent college grad at the age of 23 I elected to start investing in the stock market. I had a journalism degree (having earned a MBA later at age 30), so this was new territory. My single, independent life in New York afforded little discretionary income (rent for my studio (read “small” as in 300 square foot) apartment in the Manhattan’s East Village was a whopping $995 in 1990). New York City taxes were, and still are high. I managed to somehow sock away little bits of money in my employer- sponsored 401(K) plan and in a few no-load mutual funds in a brokerage account. At the time, automatic investments could be as small as $50 per transaction and many months that was all I could afford with my New York life. If I didn’t see the money in my bank account, it was easier to save it.

Little by little my small investments grew. As I advanced in my career I had more income to save and invest in my retirement each month and at bonus time. My savings allowed for a downpayment on a home. I bought my first at age 28 in 1995, which in hindsight was pretty cool. WIth no children in my 20s or 30s I was able to build equity in a home and save for my retirement.

Additional monies I saved went into the brokerage account that had a money market fund and gave me a way to get access to my cash if needed. This served as an emergency fund, which I never regretted saving for. There is always the chance for a rainy day. In my case, it was a flood, the kind from a burst pipe.

Change in Plans – A Big Family in My 40s

During the past few years my family has grown significantly, and all of my three children were born within less than 3.75 years as I have mentioned in my earlier story. This was not planned, but very welcomed.

With just one child to care for, plans were altered by starting a college savings plan (529), and building a new cash reserve for preschool costs. It all was pretty manageable.

The piggy bankNow with with two additional children under age two the pressure is on to maintain current commitments, including paying for childcare and their individual college savings plans. Commitments have multiplied by 3!

Does this get the sandwich label when one saves for college and retirement and they are going to happen within the same decade?

Owning a business is like having another baby. Constant care and feeding is required. Investments are needed to grow Little Green Beans. It’s rewarding and challenging to manage.

Now what about that retirement plan? Importantly, I took the step to move the investments to well-managed no-load funds and a no-fee account. All types of managed retirement plans exist for IRAs for those like me who have been saving for 20+ years.

  • Many account types and mutual funds carry high fees and I did not want any of them, no thank you.
  • A benefit is visibility to all accounts with a great website, plus support team to call and a branch to visit when I have a question or concern. These give a busy mom piece of mind, and a way to get help when I need it.
  • (I selected Fidelity Investments and a number of options exist for those with similar priorities for saving and investing.)

Looking at my sandwich regularly will make it manageable I feel.

Visibility and the ability to plan will keep me on course as the next few years will be exciting with growing kids, a store and a book project based on this blog.

How have you effectively planned for your retirement and saving for college in your advanced maternal age? Please share your tips.