Dr, Jessica Brumley, the current president of the American College of Nurse-Midwives (ACNM) and an Associate Professor at the University of South Florida in the Department of OBGYN joins host Chris Stallman, CGC. Dr. Brumley addresses the most common questions she gets about midwives, who they serve (hint: it’s not just pregnant people) and where you can learn more about midwives in your area.

Dr. Brumley has worked in her state on quality improvement work including the Promoting Intended Vaginal Delivery and Mother-Focused Care Initiatives. Her research has focused on group prenatal care implementation and human milk and lactation optimization. Dr Brumley is an internationally recognized expert in midwifery, physiologic birth, lactation, and respectful care.

Resources mentioned in this episode:

Find a Midwife

American College of Nurse-Midwives (midwife.org)

Ep. 77 Transcript

 You’re listening to the MotherToBaby podcast, medications and more during pregnancy and breastfeeding. Ask the experts with your host, genetic counselor and mama for Chris Stallman.

This episode contains evidence based information that’s current as of the day recorded and may change as more data becomes available. To get the very latest information about this topic or other topics in pregnancy and breastfeeding, please contact a mother to baby specialist at 6 2 6 6 8 4 7 by text at 5 9 9 3 5 2 5, or through our website.

Welcome to another episode of the MotherToBaby podcast. My name is Chris Stallman, and I’m a genetic counselor, a mom of four, and a teratogen information specialist. So what that means is that I talk to people, so patients, family members, healthcare providers, about exposures that can happen before pregnancy, during pregnancy, while breastfeeding, and in cases of adoption.

And an exposure can be anything, so it could be a medication you take, it could be a vaccine, it could be something in your workplace, lots of different things can be exposures. And the good news is lots of different health care providers can also talk to you about exposures in pregnancy and breastfeeding.

In fact, our guest here today is here to talk with us about the important roles that midwives play in healthcare. Our guest today is here to talk with us about the important roles that midwives play in healthcare. Dr. Jessica Brumley is an internationally recognized expert in midwifery, physiologic birth, lactation, and respectful care.

She is the current president of the American College of Nurse Midwives and an associate professor at the University of South Florida in the Department of Obstetrics and Gynecology. Dr. Brumley has worked in her state on quality improvement work, including the promoting intended vaginal delivery and mother focused care initiatives.

Dr. Brumley, welcome to the show. Thank you so much for having me. It’s our pleasure. Can you tell us about midwives as a profession and how they’re different from other health care providers? Absolutely, happy to answer that. I think it’s important to recognize that midwifery is a unique profession.

Sometimes it can seem to be mixed in with nursing and or medicine. Um, but really, um, midwives have been practicing since the beginning of times, right? Since we’ve been having babies, we’ve needed, um, support during that time. And our focus is really on the normal physiology, right? How our body normally changes during different stages of life.

So whether it’s when we start menstruation, when we get pregnant, the stage of when we stop, right, having our menstrual cycle. All of those are normal phases and that is our focus on how do we optimize and how do we help to really support those normal processes that happen in a person’s life. And then I also just like to remind people that, so we care for people not just in pregnancy but also outside of pregnancy.

Pregnancy and can help to provide care for mom and also the newborn during the first month of life. What is the most common question you receive as a midwife? Now, I know that there’s lots and lots of those that could qualify. It’s a very loaded question that I just asked, but what are some of the more common things that you speak with most patients about?

I’ve been in my practice for a long time and so we’ve built up a lot of awareness around the profession of midwifery. For a very long time, the most common question that I got was really just around what is a midwife and, oh, so does that mean you only deliver in homes or does that mean your patients can’t get an epidural or these kinds of, I think, you know, misconceptions, um, that many people would often be surprised that I might come in with a lab coat on or, you know, look like other healthcare professionals, right, that were entering the space.

It wasn’t sort of, um, it didn’t meet their misconceptions. Um, and so we, we spent a lot of time building up awareness on, you know, the level of training that we get and, um, and the expertise that we have in this area. So let’s take it in the other direction. What is the most unusual question that you have received as a midwife?

I think what’s always really startling to me is how, um, People don’t know, um, what, uh, about their body. And so I’m always really intrigued about the kinds of questions I get about things that are really, that I know are very normal, right? And so, um, you know, when, when, when somebody asks like, Oh, there’s, there’s, Does this look right?

Right? Or does this, you know, this is happening. Um, and I’m like, right. Uh huh. Yep. That’s, you know, we deal with very intimate parts of somebody’s anatomy and those are not the kinds of, um, the kinds of things that you often talk to your girlfriend about or your sister, your mom. And there’s always these ideas around how things should feel and look and, and be.

And so, you know, if you’re getting a random gray hair somewhere, somebody’s like,

What the kinds of questions that they ask their midwife. Understood. That’s, I, I think it’s such a good question. It’s such a great thing that there is someone that folks can ask because you say, you know, you may not talk about it with other people in your lives or your partner and you know, but there you go.

I talked to my daughter about one thing, right? One of the, one of the things like as a, as a, I don’t know, not a pet peeve of mine, but like a point that I often explain is about the number of holes that a woman has, right? you know, because you just one that urine comes out of and one where we have bowel movements from and another one where a baby comes out of or you have your menses out of.

And there’s a lot of people who don’t know that, right? Like adult grown people that don’t know about the difference in their anatomy. And when I say it, she looked at me and she rolls her eyes and she goes, mom, everybody knows that. And I’m like, no, everybody doesn’t know that. Oh, yeah. I mean, I love it. I love to explain things to people so they fully understand how their body works so they can take care of it the best to the best of their ability.

Yeah, absolutely. So as a midwife, what are some things that you would want every patient to know? Hmm. Uh, that you are in control. That it’s always your voice. That should be centered and, and matters that you have the right to say no. Um, can you please answer these questions for me? I’m not ready right now.

Can we, can I take a moment? Right. Um, the reason why I went into midwifery was because I heard that this was a profession that could empower people during a very important time in their life. And that that meant that they could apply what they learned at that time for the rest of their health care journey and that of their families and oftentimes, you know, mothers or pregnant people are the ones who control the health care dynamics for their whole family.

Yeah. And so making sure that I create this space that lets people know that they are the voice that matters in this room and not mine. Uh, that it’s. That’s the most important message that I, you know, can convey to anyone. Yeah. And it doesn’t go out of style. You know, it’s always a good time to remember, you know, that it is your body.

It is your life. It is your family. And, and that, you know, the outcome for you is what everybody should be working towards. That’s right. Yeah, absolutely. So Dr. Rumley, for being with us today. But before you go, is there a final thought you would like to leave our audience with? Everyone deserves a midwife.

Everyone deserves the kind of care that a midwife provides. You can find a midwife in your community. If you can’t find a midwife in your community, ask for a midwife in your community. This is the kind of care that everyone deserves. Absolutely. I could not agree with you more. Thank you. And of course, in our show notes, we’ll have some information about the American College of Nurse Midwives.

That way, if folks are looking to learn more about this very important and super exciting profession, they can start there. Thank you so much. Oh, my pleasure, Dr. Brumley. Thank you for shining a light on midwives. As you say, you know, it’s, it’s not always super well known. So definitely good information to have.

And that’s going to do it for this episode of the mother to baby podcast. Be sure to hit that subscribe button. So that way you never miss a new episode and you can go back and listen or relisten to some of those older episodes as well. You can find us on iTunes, Spotify, audible, or however you like to listen to podcasts.

And if you wanna be on the podcast or if you have an idea for the show, we would love to hear from you. Please feel free to email us at Contact us@mothertobaby.org and mother to Baby is here to answer your questions about exposures before and during pregnancy. While breastfeeding or if you have questions about exposures and adoption, you can reach us by phone at (866) 626-6847 by text at 8 5 5 9 9 9 3 5 2 5.

You can visit us on our website, mothertobaby. org, and there you can chat with an information specialist. You can look at our many blogs, information pages, our hundreds of fact sheets that are available free in English and in Spanish. And you can also listen to our podcast or find out how you can participate in our pregnancy studies.

If you would like to support the MotherToBaby podcast, as well as all of the ways we get critical pregnancy and breastfeeding health information to you at home, we have a new way to do just that. InCircle is our new monthly giving society that helps ensure we can continue to provide our services at no cost to you.

Join the community today and encircle parents and babies in health. Members will be recognized on the podcast and website. Visit mothertobaby. org slash donate today. Until next time. Remember mother to baby is here for you. Take care. Mother to baby is a song. Service of the nonprofit Organization of Teratology Information Specialists and supported by the Health Resources and Service Administration of the US Department of Health and Human Services.

It’s made possible through generous donations from listeners like you. To learn more about MothertoBaby, please visit mothertobaby.org.

 

The Bilingual Website is the Latest Addition to the Non-Profit’s Toolkit to Promote Healthy Pregnancies and Reduce Birth Defects

BRENTWOOD, TN – ¿Hablas español? ¡Sí! In time for January’s Birth Defects Awareness Month, MotherToBaby is proud to announce the launch of its fully bilingual (English/Spanish) website. It’s the first of its kind for housing an extensive bilingual library of fact sheets on everything from alcohol to zolpidem during pregnancy and breastfeeding as well as connecting bilingual experts with parents and healthcare providers.

Only select portion of MotherToBaby’s resources were previously available in Spanish. The now fully bilingual website is designed to fill the gap in the disparities of health education information for pregnant and breastfeeding individuals who are Spanish-speakers. MotherToBaby wants to improve birth outcomes in the Latinx community by giving improved access to language-appropriate resources to families and health professionals.

“It’s our experience that all parents and parents-to-be want the best information possible in order to have a healthy baby,” said Lorrie Harris-Sagaribay, MPH, a bilingual teratogen information specialist and the MotherToBaby President-Elect. “No matter what the language they speak is, we want everyone to have access to the best, expert health information possible. Making our free resources available in the second most-used language in the U.S. will help us reach many who are currently underserved.”

MotherToBaby, a no-cost service of the international non-profit Organization of Teratology Information Specialists (OTIS), has been available to the public for more than 30 years. During that time, it has become the leader in birth defects research as well as answering questions the public has about exposures, like medications, vaccines, beauty products, herbal supplements, workplace exposures and much more, during pregnancy and breastfeeding. MotherToBaby is a suggested resource by many federal agencies including the Centers for Disease Control and Prevention (CDC).

The fully bilingual website comes on the heels of other Spanish resources previously available including more than 300 fact sheets, a phone information service (866-626-6847), texting line (855-999-3525), and live chat and email (available on MotherToBaby.org). Just some of the website updates include one-stop resource hubs organized by exposure topic and health field, a FREE online materials ordering system for patient education and materials, and fully translated information about the research arm of the organization, MotherToBaby Pregnancy Studies. Much of the information that the scientific community knows about medication and vaccine use during pregnancy comes from observational studies. With accessible information about study participation in Spanish, MotherToBaby is aiming to increase participant diversity and better reflect the community that may need to take these drugs to treat or prevent illness.

“The risk to the developing baby from certain exposures during a pregnancy can vary greatly depending on timing of the exposure and much more,” said Harris-Sagaribay. “To be able to provide information tailored to a pregnant person’s personal circumstance allows for better informed decision-making. I’m proud to be part of a service that empowers parents like that not only in English but also in Spanish.”

The Spanish-language website is just one of MotherToBaby’s latest effort in making health education information more accessible to people outside of native English speakers. MotherToBaby is exploring the expansion of its bilingual resources to make them available in more languages. For example, it recently made its COVID-19 mRNA Vaccines fact sheet available in Arabic, Chinese, Portuguese, Tagalog and Vietnamese.

Visit the new Spanish-language website at MotherToBaby.org/es. The MotherToBaby website is not intended to be a substitute for professional judgment. Users should consult personal healthcare providers for pregnancy and breastfeeding advice related to their particular situation.

More about OTIS and MotherToBaby

The Organization of Teratology Information Specialists (OTIS) is a professional scientific society made up of individuals engaged in assessing and evaluating risks to pregnancy and breastfeeding from environmental exposures. Members include, but are not limited to, specialists in the fields of obstetrics and gynecology, pediatrics, genetics, dysmorphology, perinatal epidemiology, teratology, behavioral teratology, pharmacy, genetic counseling, nursing, midwifery, maternal and child health, public health, and includes experts that provide MotherToBaby services and researchers that conduct MotherToBaby Pregnancy Studies.

MotherToBaby is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $6,000,000 with zero percentage financed with non-governmental sources. The contents of this release are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS or the U.S. Government. To learn more about MotherToBaby and OTIS, please visit www.MotherToBaby.org.  

Media Contact: Nicole Chavez, 619-368-3259, nchavez@mothertobaby.org

In recent years, plant-based diets have become more and more popular. People choose to go vegetarian for a variety of reasons including health benefits, sustainability concerns, and ethical motivations. Whatever the reason, this type of diet can be healthy and nutritionally adequate, even during the reproductive years. However, during pregnancy, a bit of planning may be required to make sure the developing baby is getting all the nutrition necessary from a plant-based mom.

First, let’s talk about different plant-based diets. Some people choose to avoid meat on occasion such as those who participate in “Meatless Mondays.” Others commit fully to a vegetarian lifestyle, which means avoiding all forms of meat. Lacto-vegetarians also exclude eggs from their diet, while ovo-vegetarians also avoid dairy. Vegans have more restrictions, avoiding any products that come from animals such as eggs, dairy, gelatin, and honey. The good news is that there are still many food groups available to vegetarians and vegans. Fruit, vegetables, grains, nuts, legumes, meat substitutes, and dairy alternatives are all still on the table.

During pregnancy, nutritional requirements change to meet the needs of the developing baby. Most women can easily meet these new requirements by taking a prenatal vitamin with 100% of the daily value (DV) to get all the important vitamins and minerals. However, vegans and vegetarians may require a different approach to keep mom and baby as healthy as possible.

Let’s take a look at B12 first. Vitamin B12 is involved in the development and function of the central nervous system, formation of red blood cells, and DNA synthesis. During pregnancy the recommended dietary allowance (RDA) for B12 is 2.6 mcg for everyone. However, vegetarians and vegans are at risk of deficiency since this vitamin only occurs naturally in products that come from animals. To ensure that enough is consumed, plant-based moms-to-be should focus on eating foods fortified with B12. Blood work can also help to identify any deficiencies, and if a woman is found to have low B12 during pregnancy, a higher dose supplement may be recommended by the health care provider.

Iron is another vitamin that requires a second look for those with a veggie diet. During pregnancy, iron requirements increase due to a rise in plasma volume and red blood cell concentration. For women who eat meat, an RDA of 27 mg is advised. However, for vegetarians the RDA is 1.8 times higher, meaning 48.6 mg per day is needed. Iron can be obtained from plant-based foods but it is not as bioavailable as iron from meat, so supplementation is usually required.

Around 90-95% of pregnant women don’t consume enough choline, regardless of what diet they follow. An RDA for choline of 450 mg is suggested for every pregnant woman. Soybeans, wheat germ, kidney beans, and eggs are some of the best plant-based forms of choline, but this vitamin can also be obtained from a dietary supplement. Choline has been shown to improve liver health, memory, mood, and other brain and nervous system functions.

What about calcium? Vegetarians who still consume milk, cheese, and yogurt may not be too worried about this one. However, it’s known that certain plant foods contain large amounts of oxalates, a naturally occurring compound that can reduce the amount of calcium absorbed from food. For example, a cup of spinach contains about 30 mg of calcium, however because this food has a high oxalate content, the calcium is not well absorbed by the body. Another interesting point about calcium is that smaller doses are better absorbed. This means that spacing out a supplement and calcium rich foods throughout the day may be a better approach than taking it all at once. Lastly, it’s important to note that calcium should always be taken with vitamin D since the body needs vitamin D to absorb calcium. An RDA for calcium of 1,000 mg/day is advised for women over the age of 18 during pregnancy, regardless of diet type.

The term “Omega 3s” commonly refers to alpha-linolenic acid (ALA), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA). It is suggested thaf pregnant women get 1.4 grams/day of ALA, however, there is no official dose for DHA or EPA that has been established for pregnancy. ALA is present in plant oils, such as flaxseed, soybean, and canola oils. Walnuts and chia seeds are also good sources of ALA. The problem is that ALA does not easily convert to DHA in the body, so even when a woman who is plant-based consumes a good amount of ALA they can still have low DHA levels. Although there is no official recommendation in place to take a DHA supplement during pregnancy, vegetarians and vegans can talk to a health care provider to determine if it makes sense to take an algae based one.

A blog about nutrition wouldn’t be complete without talking about folic acid, especially during January’s National Birth Defects Awareness Month. When folic acid is taken for at least one month prior to pregnancy, this important vitamin reduces the chance of neural tube defects (a type of birth defect affecting the baby’s brain and spinal cord) by as much as 50-70%! Like everyone else, vegetarians and vegans should get 400 mcg/day prior to pregnancy and 600-800 mcg/day during pregnancy from a supplement.

As a vegetarian myself, if I had a dollar for every time someone asked me about protein I’d be a millionaire by now! For some reason, well intentioned friends and family seem to be very concerned about this topic – especially during pregnancy! A general recommendation of 71 grams of protein/day is currently in place for everyone during pregnancy. Vegetarians can easily meet this requirement by consuming foods like yogurt, chia seeds, quinoa, beans, eggs, and certain vegetables. Vegans can focus on many of the above foods as well as tofu, lentils, soy milk, and nut butters. Although most women can meet the RDA with the right attention to diet, if you’re concerned about not getting enough protein during pregnancy, your health care provider can refer you to a nutritionist to help further.

Pregnancy as a vegetarian or vegan doesn’t have to be stressful, but some additional planning may be needed. When possible, focus on getting nutrients from your diet. However, to meet RDAs during pregnancy, or if a deficiency is noted by blood work, supplementation can be beneficial. If you ever have any questions about vitamins, minerals, omega 3s, or protein during pregnancy, contact a MotherToBaby specialist to receive individualized counseling. With the right approach, a plant-based mom and baby can get all the nutrients they need!

References:

Melina V, Craig W, Levin S. 2016. Position of the Academy of Nutrition and Dietetics: Vegetarian Diets. Journal of the Academy of Nutrition and Dietetics, 116(12), 1970–1980. https://doi.org/10.1016/j.jand.2016.09.025

National Institute of Arthritis and Musculoskeletal and Skin Diseases. May 2023. Bone Health and Osteoporosis. Available at: https://www.niams.nih.gov/health-topics/bone-health-and-osteoporosis

National Institutes of Health. June 2022. Choline Fact Sheet for Health Professionals. Available at: https://ods.od.nih.gov/factsheets/Choline-HealthProfessional/

National Institutes of Health. July 2024. Calcium Fact Sheet for Health Professionals. Available at: https://ods.od.nih.gov/factsheets/Calcium-HealthProfessional/

National Institutes of Health. October 2024. Iron Fact Sheet for Health Professionals. Available at: https://ods.od.nih.gov/factsheets/Iron-HealthProfessional/

National Institutes of Health. December 2024. Omega-3 Fatty Acids Fact Sheet for Health Professionals. Available at: https://ods.od.nih.gov/factsheets/Omega3FattyAcids-HealthProfessional/

Advancing the Health of Families

MotherToBaby establishes partnerships with organizations that share our interest in the health of families. We can also refer you to a number of other resources that can provide helpful information about pregnancy, birth defects, and exposures during pregnancy and breastfeeding.

About MotherToBaby

MotherToBaby, a service of the non-profit Organization of Teratology Information Specialists (OTIS), is the nation’s leading authority and most trusted source of evidence-based information on the benefit or risk of medications and other exposures during pregnancy and while breastfeeding. We specialize in answering questions about the benefit/risk of exposures, such as medications, vaccines, chemicals, herbal products, substances of abuse, maternal health conditions and much more, during pregnancy or breastfeeding. Our no-cost information service is available to women who are pregnant and/or breastfeeding, their family members, health professionals, and the general public via chat, text, phone, and email in both English and Spanish.

MotherToBaby is a suggested resource by many agencies including the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration’s Office of Women’s Health. Every year, MotherToBaby services are accessed more than 2 million times. Our one-on-one counseling sessions, fact sheets, blogs, podcasts, and other resources provide essential information about exposures for pregnant and breastfeeding people, as well as healthcare providers.

We also conduct state-of-the-art observational research on the safety of medications and vaccines in pregnancy. 9 out of 10 women who are pregnant in the United States take medication but evidence on the safety of many medications during pregnancy is often lacking. Our observational MotherToBaby Pregnancy Studies aim to provide this much-needed information so women who are pregnant and/or breastfeeding and their health providers can make more informed treatment decisions.

Read more about the history, vision, mission, goals, leadership and funding of our parent organization, OTIS.

Our Affiliates

The MotherToBaby network consists of 11 affiliates housed at acclaimed universities and hospitals across the United States and Canada. These affiliates provide the MotherToBaby service to people living in all 50 U.S. states, the U.S. territories, and the province of Quebec in Canada. Our information specialists are available to residents of the United States and its territories. Opportunities to join a study are available to residents of the United States, the U.S. territories, and Canada. 

We encourage you to find your affiliate and to connect with the team that is working to reduce the chance of preventable birth defects in your community.

Annual Report

Learn more about the impact we made educating the public on the benefits and risks of exposures during pregnancy and lactation to improve maternal and child health.