Do not rely on or create assumptions about a person’s identity or family structure during care.
Example given: a person who is in the process of transgendering described as a woman who just birthed a baby and may have features like a full beard. The guidance is: I don’t ask questions or assume; let the person tell you who they are.
Similarly, families can be complex (e.g., a polygamy-type family with a dad and another partner who has a child, plus the mom). Be aware that appearances (e.g., someone in the room who looks like an older grandfather) may not align with expected roles; do not assume.
Be prepared for varied family dynamics and ensure you are following the patient’s self-identification and preferences.
Clinical-context example: at Baptist South, there is a Tuttweiler Women’s Prison contract. This can mean a mom may deliver with prison guards present and no typical family support.
Program benefit: if the mother attends childbirth classes, they will allow breastfeeding and pump milk; the program can collect the breast milk.
If she attends these classes, she also gets a doula through the program.
Doulas and labor support
Doulas help women through labor; there are many in Montgomery, often private pay.
Insurance typically does not cover doula services.
A doula can work in conjunction with a nurse midwife.
There is a wide variety of birth support options to be seen in practice.
Fertility considerations related to BMI
Very high BMI can create fertility problems.
Very low BMI can also create fertility problems.
Diet and fertility
Diet influences fertility; suggested focus on unsaturated fats, vegetables, fruits, and an overall healthy diet.
Encourage reflection on what was learned in nutrition class about diet before pregnancy.
Folic acid and preconception nutrition
All women of childbearing age should be on a folic acid supplement.
Folate can be obtained from foods, but oral supplementation is preferred.
Nutrition resources and the WIC program
WIC stands for Women, Infants, and Children; a national program founded in the 1970s to help reduce rickets and support nutrition.
Accessibility: available in every state; supports children up to age 5 and pregnant or breastfeeding mothers.
Eligibility is income-based and not limited to Medicaid or lack of insurance; a person with Medicaid or private insurance can still qualify if income criteria are met.
WIC issues an EBT-type card (SNAP-like) for purchasing healthy foods.
Services include nutrition counseling from a dietitian at a health department or WIC clinic.
Real-world example of eligibility: a mom on Blue Cross Blue Shield who is working may still qualify due to income level.
Practical considerations about diet change during pregnancy
Common pattern: upon learning they’re pregnant, some women commit to cutting caffeine and adopting a healthier diet and stop smoking; postpartum, some of these changes revert or relapse.
Emphasis: education is critical to support lasting behavioral changes.
Smoking, secondhand smoke, and fertility
Smoking adversely affects fertility.
Secondhand smoke exposure is a concern during pregnancy planning and pregnancy.
Exercise during pregnancy
Women who are healthy and exercise during pregnancy tend to experience shorter labor.
Family Identity and Birth Settings: Practical Implications
Healthcare providers should recognize and respect diverse identities and family structures.
When engaging with patients in settings like prisons or contracted programs, understand the support systems available (e.g., breastfeeding support, pumping, doula services approved through contracts).
Clarify roles in the delivery room only as the patient identifies them to avoid mislabeling family members (e.g., misidentifying a father or grandfather).
Provide information about available resources (WIC, dietitian counseling, doulas) and how to access them given income-based criteria.
Doulas, Midwives, and Labor Support: Roles and Realities
Doulas:
Support labor and birth, not medical care.
Frequently private-pay; insurance coverage varies and is uncommon.
Can collaborate with nurse midwives or obstetric teams.
Nurse midwives:
May work in conjunction with doulas for comprehensive birth support.
Private pay and insurance considerations:
Expect variability in coverage; discuss options and costs with patients and programs ahead of time.
Nutrition, Fertility, and Prenatal Care: Key Points
Preconception diet and fertility:
Emphasize unsaturated fats, fruits, vegetables, and overall healthy diet.
Folic acid supplementation is important for all women of childbearing age.
WIC program specifics:
Founded in the 1970s to combat nutritional deficiencies like rickets.
Covers pregnant, breastfeeding mothers, and children up to 5 years old.
Eligibility is income-based; can include people on Medicaid or those with private insurance if income qualifies.
Benefits include EBT/SNAP-style benefits and access to dietitians at health departments or WIC clinics.
Behavioral Health and Lifestyle: Practical Guidance
Expectation vs. reality in behavior change:
Many plan to reduce caffeine, improve diet, and quit smoking during pregnancy, but some revert postpartum.
Smoking:
Reduces fertility and has risks in pregnancy; address both maternal and secondhand exposure.
Exercise:
Regular physical activity during pregnancy is associated with shorter labor and overall health benefits.
Real-World Relevance and Ethical Considerations
Ethical practice requires respecting patient self-identification and avoiding assumptions based on appearance or context.
Incarceration contexts (e.g., Tuttweiler contract) present unique circumstances for support, breastfeeding policies, and postpartum care; ensure policies are understood and communicated to patients.
Economic and access considerations are central: WIC, EBT/SNAP, and dietitian support can play a crucial role in improving maternal and infant outcomes.
Key Terms and Concepts
Doula: a trained birth companion who provides continuous physical, emotional, and informational support to the mother before, during, and shortly after birth.
Nurse midwife: a licensed midwife who provides obstetric care and can work with doulas.
WIC: Women, Infants, and Children program; nutrition support program funded in the 1970s.
Tuttweiler Women’s Prison contract: program context that can influence who attends childbirth classes, breastfeeding policies, and doula access.
EBT/SNAP: Electronic Benefits Transfer program for obtaining food assistance.
Folic acid: essential prenatal nutrient recommended for women of childbearing age.
BMI: body mass index; extremes can affect fertility.