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A Road Map for Moms: Beating Stress and Overcoming Fatigue

Dr. Amy Johnson-Grass

Don’t skip breakfast!

Starting your day with breakfast is a quick and easy way to jump-start your metabolism. Eat something within 30 minutes of getting up.  Make sure to get in 12-15 grams of protein with your breakfast. This could be:

  • A protein shake with fruit and greens
  • Eggs, veggies and whole grain toast
  • Greek yogurt and fruit

-> Check out our blog for great recipe ideas!

Be Mindful of Meals and Snacks!

Moving forward from breakfast, make sure you have protein with each meal and snack. It is important to stick to 3 meals and 2-3 snacks per day. Here are some great, healthy protein options:

Source

Amount

Grams of Protein

Fish, cold, deep water

1 ounce

7g

Turkey – organic

1 ounce

7g

Tofu

½ cup

10g

Whole Beans

½ cup

7g

Quinoa

½ cup

11g

Brown Rice

½ cup

3g

Yogurt

1 cup

8-14g

Egg, whole

1

7g

Nuts

¼ cup

8g

Stay hydrated!

Drink 80 ounces of water daily. Adding lemon or lime to your water is a great way to make it a little more interesting! Hold yourself accountable and purchase a reusable water bottle and keep track of how many you have to drink each day to reach your goal.

Basic Supplements to keep on hand!

Multivitamin: Try and find a food-based multi. These are easy to digest and absorb.

B complex: B vitamins have an important role. They help convert our food into fuel for our body, providing more energy throughout the day.

Adrenal Support: Continued stress causes fatigue of our adrenal system. There are many ways to help keep the adrenal system strong and well supported. Some examples include: Vitamin C, Magnesium and B vitamins. There are also a few herbs that are helpful but my favorite is Rhodiola Rosea, which can be taken as a capsule or tincture.

Fish Oil: Fish oil supports healthy cholesterol levels and also is a great mood booster!

Vitamin D3: When choosing a Vitamin D3 supplement, it should have at least 5,000 IU. Not only does healthy levels of Vitamin D3 help maintain a health immune system, it is also another great vitamin to help with mood.

Get Your Labs Checked!

These basic labs are so important to keep on top of as a woman. They are frequently missed so be sure to ask your doctor the following:

  • Iron (hemoglobin, ferritin)
  • Vitamin D3
  • B12
  • Thyroid

Schedule Some “ME” Time!

This is easier said than done but it will make a huge difference! It doesn’t even have to be more than 30 minutes. Some days take longer breaks if you can, other days you may only get 5 minutes of deep breathing. Here are some examples of things you can do to relieve stress:

  • Exercise. Yoga is a wonderful way to calm your body down and rejuvenate.
  • Reading. Grab a book or magazine find a quiet place and let the world round you melt away for a little while.
  • Laugh. Get a few girls together and have an hour or two of fun and laughter. It does wonders.
  • Take a bath. Buy some Epsom salt and your favorite essential oil and take a 15-minute bath before bed.

Sleep!

Try and get to bed by 10pm every night. Having a full 8 hours of rest is ideal

 

Don't miss Dr. Amy Johnson-Grass next Sunday, September 11 at 11:00am on the Mom Show with my Talk 107.1. The topic is A Road Map for Moms: Beating Stress and Overcoming Fatigue. 

Miscarriage: Common Concerns & Questions

Photo by monkeybusinessimages/iStock / Getty Images

Pregnancy following a miscarriage can feel like a rollercoaster of emotions. While miscarriages are unfortunately quite common, occurring in approximately 10-20 percent of pregnancies, they can often make the miracle of pregnancy feel like it’s lost some of its innocence. An experience that was once only filled with excitement and joy is now riddled with anxiety, questions, lingering grief and doubts. Here are some common concerns and questions you may have if you are trying to get pregnant again following a miscarriage.

Why did it happen to me? 

One of the most difficult aspects of having a miscarriage can be the feeling of not understanding why it happened. Having answers or a reason why something has happened can sometimes make it easier to accept and move forward. With miscarriages, there is often no explanation, leaving the parents feeling bewildered and distraught. In most cases, miscarriages occur because the fetus is not developing properly or there is a chromosomal abnormality. The abnormalities occur by chance as the embryo develops and have nothing to do with anything you did or did not do during or before your pregnancy. It is rare that a miscarriage happens due to something inherently wrong with the mother’s health or habits. Typically, in these uncommon cases there is an existing health condition such as poorly controlled diabetes or an undiagnosed uterine problem. More often than not, the cause is unknown.

Will it happen again? 

Because most miscarriages are typically due to unexplained and random chromosomal abnormalities, your chances of having another miscarriage remain about the same as your previous pregnancy: between 10 and 20 percent. However, only approximately 2 percent of women have two miscarriages in a row, so you can take comfort in knowing that the chances of this occurring are rare. Most women fortunately go on to have healthy pregnancies and healthy babies. 

Is there anything I can do to prevent it? 

Unfortunately, because miscarriages are often due to random chromosomal abnormalities or the fetus not developing properly, there is usually nothing that can be done to prevent their occurrence. However, there are measures that you can take prior to and during pregnancy to help ensure a healthy, full-term pregnancy for you and baby. These include:

  • Starting a regular prenatal vitamin regimen several months prior to trying to conceive
  • Eliminating unhealthy habits like smoking, alcohol, recreational drug use and excessive caffeine consumption before trying to get pregnant
  • Maintaining a healthy weight and eating a nutritious and balanced diet
  • Avoiding risky activities, contact sports and other scenarios in which you might experience abdominal trauma.

Am I ready to be pregnant again? 

This is a question that only you (and your partner) can truly answer. Miscarriages can be physically and emotionally trying and allowing yourself time to grieve the loss of your baby is an important step towards healing. It is not uncommon to feel sadness, anger, confusion, and even guilt following the loss of a pregnancy. Take the time necessary to process your grief, whatever that time frame may be.

How long do I need to wait before trying to get pregnant again?

Following a miscarriage, it’s not uncommon to be wondering when you can try to get pregnant again. For many women, the urge to become pregnant again with a viable pregnancy becomes quite strong following a loss. If you are eager to conceive again after your miscarriage, talk to your doctor or midwife to determine when it is safe for you to try again. Typically, you will be advised not to have sex for two weeks following the miscarriage to prevent infection. If you do not experience any complications, your period should return within six weeks and your cycle should return to normal. Although many doctors and midwives will advise you to wait one or two menstrual cycles before trying to conceive, some research suggests that there is no medical need to wait. 

What will I do if it happens again?

If you do experience more than one miscarriage, it is a good idea to ask your doctor or midwife about having additional testing done to rule out any underlying medical issues that may be causing them to occur. This may include hormone imbalances, uterine fibroids, obstructions in the fallopian tubes, autoimmune disorders and other medical issues affecting fertility and pregnancy. Tests that your doctor or midwife might order include bloodwork, ultrasounds, chromosomal tests, and other exams and procedures to rule out problems with uterus, cervix and fallopian tubes.

How can I process the grief I’m experiencing?

It’s not uncommon to feel alone in your grief following a miscarriage as they are unfortunately often not a subject that is openly discussed. Particularly if the loss occurred before you had shared the news of your pregnancy with family and friends, you might feel as though you have no one to turn to as you process your grief. The grief that accompanies the loss of a pregnancy should not be experienced alone. Reach out to friends and family members who can support you during this time and who may have even experienced loss themselves. Seek out online support forums for women who have experienced a miscarriage to connect and hear stories of hope and future pregnancies. Let your partner know how they can best support you during this time whether it’s simply through listening or through creating some sort of small memorial honoring your baby in your home. Talk, write, cry, listen, hug and grieve as long as you need to in order to move past this difficult time in your life.

Trying to conceive and becoming pregnant following a miscarriage can be a scary and confusing journey. Take comfort in knowing that most women will go on to have healthy pregnancies and healthy babies following a miscarriage. For more information about coping with loss, pregnancy, natural birth, the postpartum period and infant care, contact Health Foundations for a free consultation with a midwife. We would love to support you in your journey.

And Then There Were Three: Nurturing Your Relationship after Baby

Nurturing Relationship After Baby

Having a baby is a life changing transition for couples that can be filled with excitement, newness, awe, learning and exhaustion. Gone will be the days of leisurely Saturday mornings, spontaneous date nights, uninterrupted romantic evenings and sleep….yes, that will be gone for a while too. All these adjustments in combination with caring for a new baby can cause a strain on even the best of relationships. Here are some helpful tips on how to nurture your relationship while nurturing your newborn.

Family With Newborn
  1. Connect with each other every day: Even if it’s a 10 minute debrief about your day while reheating a freezer meal at 9:00 PM because that’s the first chance you’ve had for dinner, take the time to connect. Consider these ten minutes a team meeting in which you touch base with your favorite teammate in this crazy game of becoming a family. Taking time to listen to one another, show support, and offer a hug or encouraging words can revitalize you both for the next 24 hours.
  2. Make simple loving gestures: Whether it’s popping an extra bagel in the toaster oven when you make your breakfast for your partner, sending an unexpected loving text, or bringing home a favorite treat, little gestures in the trenches of new parenthood make a big difference. In all the excitement and exhaustion of the new baby, it’s nice to know your partner is still thinking of you too.
  3. Plan date nights: Date nights, like you once knew, may be hard to come by these days. However, a date does not have to involve a fancy restaurant or movie and can even be had in the comfort of your own home. Try trading off who will plan the date night and surprising each other with the plan for the evening. Get creative with staying home by doing things like pizza making, games, movie marathons, or maybe a fun project for your home together. And once you’re comfortable leaving baby for a couple hours with a family member or trusted sitter, go on a real date!
  4. Get intimate: And no, this does not have to mean sex. The postpartum period, particularly for women, can be a time of decreased libido. Between recovering from birth, fluctuating hormones and breastfeeding, many moms just want to sleep when their head finally hits the pillow at night. Intimacy can include cuddling on the couch, taking the time to kiss or hug throughout the day, holding hands while watching a TV show or more adult rated fun if you’re feeling up for it! It’s easy to let this aspect of your relationship slip when you are feeling exhausted, overwhelmed and unsexy. Do your best to keep the flame lit in little ways regularly. 
  5. Show appreciation for one another: Being new parents is often coupled with feeling like you are both constantly treading water. Between taking care of baby, keeping up with the housework, providing for the family, paying the bills, feeding the dog, keeping the refrigerator stocked and a dozen other necessary chores, it can often feel like a thankless job on both sides. Take the time to acknowledge everything your partner does on a daily basis to keep the family alive and well. A thank you and an acknowledgement of all the hard work from both parents can be just what we need to feel better at the end of a hard day. 
  6. Continue to support your partner’s interests and hobbies: Whether it’s a weekly yoga class, the fantasy football draft or simply a hot bubble bath with some yummy aroma therapy, allowing your partner time to take time for themselves will help them be a better parent and partner. We all need time to recharge, enjoy our hobbies and indulge a little bit and this is particularly important when you are adjusting to the major life transition of being a new parent.
  7. Communicate: Your partner should be your safe place where you can be vulnerable and share what you need and how you are feeling. Being a new parent, while one of the most amazing adjustments of your life, can also be quite overwhelming. Share your feelings, fears, victories and road bumps with your partner. Ask for help if you need it, or a hug, or advice. Being parents is like being teammates for the most special sport of your life. 

Don’t be distressed if your relationship seems to have taken a backseat since your baby has arrived. This is completely normal for couples as they navigate the overwhelming journey of parenthood. Just remember that this period of sleeplessness, newness and stress will pass and you will come out alive! The more that you and your partner can use this life changing transition to draw closer to one another and grow as parents and partners, the stronger you will come out in the end. 

For questions about pregnancy, natural birth, postpartum health and women’s services, contact Health Foundations for a free consultation with a midwife and for a tour of our Birth Center. 

Tips for Hiring Your First Caregiver

Hiring First Caregiver

You have a new baby. Suddenly, your life revolves around this tiny perfect human and you feel as though you are wearing your heart on the outside of your body. Whether you are returning to work or have decided you just need a few hours to yourself each week, hiring a caregiver for your child can be a very scary and overwhelming prospect. Here are 10 tips to help you find the best caregiver for your family.

  1. Decide what you need and want in a caregiver: Are you looking for someone who can work in your home full-time when you return to work or just for a few hours each week? Do you expect your caregiver to help out with household tasks like laundry and tidying or will their sole focus be caring for your baby? Is it necessary that your caregiver has a car and a clean driving record or is it okay if they arrive via bus or need to be picked up? These are all important factors to consider when determining your caregiving needs. Take the time to write a thorough job description identifying all your needs and wants for a caregiver and don’t forget to include what you are willing and able to pay. Indicate the type and length of relevant childcare experience you require and any other criteria that is important to you like a college degree, CPR and First Aid certification or previous child development coursework. Being specific with your needs up front will help potential caregivers know if they are qualified for the position before applying.
  2. Allow time for the search: Hiring a caregiver for your baby is not a process you want to rush. Allow plenty of time for interviewing multiple candidates, calling references, conducting trial periods and deciding who will be the best fit for your family. You should start your childcare search at least two months prior to when you will need the caregiver to begin. Deciding who you will entrust with your most precious child is not something you want to do in haste.
  3. Connect with friends and family members for referrals: What better reference than one that comes from someone you already know and trust. When you begin your search for a caregiver, reach out to other parents you know and ask them who they would recommend. Ask family members whom you trust and who know your family well, who they would suggest you contact. You may even be lucky enough to have a family member who volunteers to help with the caregiving of your baby.
  4. Consider using a reputable nanny agency: If your personal connections aren’t rendering any great referrals, consider using a professional agency with a good reputation to help you with your search. Using a childcare agency has the added benefit of providing you with candidates who have already been vetted, gone through a background check and determined to be qualified for caring for babies and children. While you may pay a fee up front for this type of service, the peace of mind in the long run will be worth it.
  5. Don’t cut corners on the interview process: While it can be helpful to begin the process with a phone interview, make sure that you meet all serious potential candidates in person. Prepare your questions for the interview ahead of time and allow up to an hour to spend with each applicant. During your time together, you will want to ask questions about experience, child rearing beliefs, what they plan to do with your baby during their time together and any other areas of importance to you. It’s a good idea to ask how the caregiver might approach certain scenarios and how they have handled challenging situations in the past. If possible, have the potential caregiver interact with your child during her visit so that you can see her degree of comfort caring for an infant and how your baby responds.
  6. Call their references: Ask for at least three references from each potential caregiver and actually call them all personally. Make sure they provide you with references that can speak to their professional experience caring for babies and children and not just personal friends or family members. Ask each candidate’s references to share strengths and weaknesses they noticed while working with them and be sure to ask about any reservations they may have in recommending them for future positions.
  7. Ask for a background check: Unless you are hiring a friend or family member for the position, you are essentially hiring a stranger to work in your home and care for your baby. A background check is an important step to ensure that you are hiring the person you think you are hiring and to rule out the possibility of any criminal background. If you find your caregiver via an agency or online nanny website, they may already have a background check on file. If not, you can easily find back ground check services online to conduct varying degrees of searches. Do not skip this step before employing someone in your home with your child.
  8. Make sure they respect your parenting beliefs: If you are adamantly against letting your baby, “cry it out”, and your nanny thinks it’s okay to do, we can guarantee this will not be a good fit. It’s important that your caregiver has a good understanding of your parenting style and beliefs and is comfortable following them while in your home. You will want your child to ultimately feel that it is a seamless transition from parent to nanny in terms of the type of care that is provided. Your nanny should be working with you, not against you, to raise your baby the way you have decided you want him raised.
  9. Conduct a trial period: Decide upon your top candidates after the interview process and do a trial period with each of them. You can do a trial day or week depending on how much time you would like to assess the fit. During this time, stay home and observe how they interact with your baby and their degree of comfort and ease caring for your little one. Do short excursions away to see how your baby adapts to being left with another caregiver. This will also give you and your caregiver the opportunity to get to know one another better and for her to ask any questions she may have about your baby or home. 
  10. Create a contract: Once you have decided on a good fit for your family, put all your expectations, agreements, and terms of employment on paper, review it with your new nanny, and have both parties sign and date the document. Make a copy for your new caregiver and keep one for yourself. This way, if issues arise in the future about expectations or care provided, there is a contract to reference. 

With the proper preparation and thought, finding the right caregiver for your child can be a rewarding and beneficial experience for all involved. Needless to say, this person will be one of the most important people you will hire in your life as they will be responsible for love and care of your baby in your absence. Take the time to do it right—it’s worth the peace of mind.

Baby Friendly Activities for New Moms

Baby Friendly Exercises

Being a new mom can be isolating at times. Even though you are home and loving snuggling up to the new love of your life, you may also be itching to get out of the house and interact with other adults! The good news is that there are so many activities available now for moms and babies in the community. From swim and exercise classes to play groups and mom and baby yoga, with a little effort to get out of the house, you and your baby can be social butterflies in no time. Here’s a list of ideas and local options for new moms in the Twin Cities.

  • Breastfeeding Support Groups: Breastfeeding support groups are a great first social activity for mom and baby as you will find the littlest of little babies at these gatherings and you can gain valuable help and knowledge from a lactation consultant. This is a great way to get help with baby’s latch or transitioning off the nipple shield and many other breastfeeding challenges that may arise. You are also usually able to do pre and post-feed weigh-ins to determine how many ounces your baby is getting per nursing session. Here are some local options for moms looking to connect with other nursing moms.
  • Mom and Baby Yoga: Mom and baby yoga is another wonderful bonding activity for you and your little one in those early months. Most mom and baby classes are open to babies as young as 8 weeks of age and involve small motions for baby that can aid in digestion, sleep and soothing while providing a relaxing way for mom to distress. Mom and baby yoga classes are anything goes as far as breastfeeding, diaper changes and crying babes, so do not worry if your baby isn’t having a ‘Zen’ day. Check out these locations for mom and baby yoga classes in the community.
  • Story Time: You are never too young for the joy of reading. You may have even read to your baby in the womb! Now that your little one is here, baby story times are a great way to get out of the house, meet other moms and enjoy a story or two with your baby.
  • Baby Signing Classes: Baby signing classes are a great way to jump start excellent communication between you and your baby. Although your baby may not be able to return sign with you until 8 or 9 months, they understand well before they are able to communicate. The earlier you begin signing with your baby, the earlier he will be able to communicate his needs to you. Baby signing is associated with earlier ability to communicate, decreased crying and even possibly a few extra IQ points down the road. Here are a few options for baby sign language classes in your area:
  • Music Classes: What better way to connect with your sweet baby than through music, movement and play. Music classes offer the opportunity to expose you baby to different sounds, songs and instruments as well as meet other moms and babies in your community. There are a few great options for music classes in the community including:
  • Swim Classes: Parent and baby swim classes are the perfect opportunity to expose your baby to the water for the first time and begin to learn some basic safety skills like back floating, flipping over from back to front and brief submersion. Most swim schools will allow you to take your first parent and baby swim class around 6 months. Typically the classes will be short to accommodate baby’s needs but will allow time for some simple instruction, games and singing. It is never too early to begin educating yourself and your child on water safety. Here are a few options for baby swim classes in the area:
  • Baby Friendly Exercise Classes: Once you’ve been cleared by your midwife or OB for exercise, you may be wondering how in the world you will find time to work out with a baby. Fear not though, there are actually many options these days for the moms who love fitness. From stroller exercise groups to babywearing barre,  these are fitness classes where moms can actually bring baby along for the ride while she gets her sweat on! Here are just a few options in the area:
  • Mom’s Groups: Lastly, mom groups are a real thing these days. They are born on Facebook, Meetup.com, through churches, birth centers and friend groups alike. Some mom groups are brought together by certain parenting philosophies or interests and others are created simply by location. Whatever the theme or lack thereof, joining a local mom group will be one of the best things you can do in that first year of being a mom to connect with other moms who are going through the same phase of life and have children that are the same age as yours. These moms will become your buddies, the ones you can talk poop and breastfeeding with without batting an eyelash. Their kids will be your kids’ playmates and hopefully your spouses will even get to know one another during family activities. There are many ways to get involved in a local moms’ group but here are just a few ideas.

As you can see, although you may feel as though you’ve been one with your couch and the Boppy pillow since baby was born, there are MANY options for you and your little one to get out of the house and connect with other new moms and babies. Give different types of activities a try to see what works for you and your baby. Try out a couple different mom groups until you find your people. Being a new parent is one of the most exciting, wonderful, terrifying things you have likely ever gone through. Why not make a few friends to join you on the journey?

For questions about natural birth, pregnancy, postpartum opportunities, classes and more, contact Health Foundations for a free consultation with a midwife and for a tour of our Birth Center.

When Your Birth Doesn’t Go As Planned

Woman Contemplating Feelings

Whether you had hoped for a home or birth center delivery and needed to transfer to the hospital, or had prepared for a natural birth and ended up having a C-section, births that do not go according to plan can be disappointing. Many mothers spend their pregnancies preparing for and creating a detailed birth plan in the hopes of having the experience they’ve always envisioned for themselves and their baby. Despite the best laid plans, birthing classes, and providers, sometimes our bodies and our babies have other plans in mind. When your birth doesn’t go as planned, it’s not uncommon to experience some negative emotions along with the excitement you’re feeling about the new baby. Many women who have experienced some form  of birth trauma  or unexpected intervention report feeling disappointed, angry, guilty, frustrated, indifferent and sometimes even resentful towards their baby or their body. These feelings usually follow birth experiences that felt out of their control, traumatic or unexpected such as having an episiotomy or emergency C-section. If your birth experience has left you feeling as though your body failed to do what you had hoped it would do, here are some ways to cope with those negative emotions and acknowledge the strength and courage in your journey.

Writing Birth Story
  1. Acknowledge your feelings: This can be difficult to do when everyone is expecting you to be overjoyed by the arrival of your new baby. However, if you are experiencing disappointment, sadness, guilt or anger about the way your delivery unfolded, it’s important to take the time to allow yourself to experience those feelings without judgment. Giving birth may be the single most important event in your life thus far and it is okay to feel sadness about any part of the labor or delivery that was traumatic or upsetting to you. If you try to push away your negative feelings about the experience, they will likely resurface at a later date as unresolved issues. 
  2. Take steps to process your grief: It is perfectly normal to experience grief following a traumatic or upsetting birth experience. It is important to allow yourself to experience the grief so that you can move forward feeling as though you have processed your feelings. Talking to your midwife or doctor and asking questions so that you can better understand and process your experience is one way to work through what you may be feeling. Two cathartic ways to process grief following birth are: telling your birth story to a trusted friend or family member or writing down your birth story. Writing or telling a detailed account of your experience can help you process your feelings of disappointment or guilt and also help you identify  all of the moments (there are so many!) of great courage and strength.
  3. Surround yourself with loving and supportive people: Limit visitors in the early weeks following your delivery to people who can be sensitive to your feelings and your experience. While not intending to be unsupportive, people may make comments suggesting that the only thing that is important is that you have a healthy baby. You can gently remind them that the experience was important to you and you are not ready to discuss it further at this time. You can also ask your partner to help play gatekeeper in the early days staving off unnecessary visitors and unsavory comments.
  4. Acknowledge the strength and courage in your story: Even if your birth didn’t end the way you had hoped, do your best to remember the amazing work that your body did. Whether you labored for 18 hours before ultimately having a C-section, endured hours of natural labor before electing to have an epidural, or had to undergo any number of interventions that were frightening or upsetting to you, your body has done an amazing thing. There is also an incredible amount of strength and courage in having to let go of your birth plan and have a birth experience that feels completely out of your control. Whatever your story is, whatever the intervention or unplanned turn your birth took, your body has done a miraculous thing.
  5. Ask for help: Whether you would like extra support from your partner, your provider, a friend to listen or to seek out a new moms’ group in your area, make the effort to reach out for help and comfort. The postpartum period, despite the awe and excitement of a newborn, can be an isolating and overwhelming experience. Adding grief from your birth experience to this mix may be too much to handle on your own. If at any point your grief begins to impact your ability to function throughout the day or seems to overwhelm the joy you have for your new baby, see your doctor or a therapist for an assessment for Postpartum Depression. Although the baby blues are a normal experience in the weeks following delivery, moms who have experienced a traumatic birth experience are more likely to develop Postpartum Depression. Ask for help right away if you feel like you might be experiencing Postpartum Depression. Click here to learn more about Postpartum Depression

If you’ve experienced a traumatic or disappointing birth experience, don’t suffer in silence. There are many women out there whose birth plans have not gone according to plan and who are left feeling guilty, angry and even depressed. There is no shame in a birth that does not go as planned and no shame in grieving the experience you did not have. Remember that you gave it your all and that is enough; that you are just as strong, powerful and amazing as all of the other mamas before you. At Health Foundations, we are here to support you throughout your pregnancy, delivery and postpartum period, regardless of whether or not your delivery took place with us, in the hospital or in the operating room. We are here for you. Contact Health Foundations to schedule a free consultation with a midwife or to find support.