Abby Block, CD(DONA), CBC

Doula & Breastfeeding Support ~ Serving Brooklyn & NYC


Folic Acid/Folate in Pregnancy: New Research on Potential Risks

Abby BlockComment

Folic Acid (otherwise known as Folate, in it's non-synthetic form) : we know it's important for a developing fetus, but should everyone be taking folate?? This article contains groundbreaking information on folic acid and an uncommon, but not rare, genetic condition.

"There’s no solid consensus, but some reports state that anywhere from 10 to 15 percent of Caucasians and more than 25 percent of Hispanics are unable to metabolize folic acid. Called methylenetetrahydrofolate reductase, or MTHFR for short, this defect refers to the MTHFR gene, which produces the enzyme responsible for converting synthetic folic acid (what’s found in prenatal vitamins and fortified grains) to methylated folate (the metabolized nutrient that protects against NTDs)."

Read the full article here.

VBACs are more likely successful if you call the midwife

Abby BlockComment

A new study shows that VBACs (Vaginal Birth After Cesarean) are more likely to be successful if a midwife provides the care instead of an obstetrician. 

You can read a portion of the abstract of the study here, and an excerpt is below:


Research is yet to identify effective and safe interventions to increase the vaginal birth after cesarean (VBAC) rate. This research aimed to compare intended and actual VBAC rates before and after implementation of midwife-led antenatal care for women with one previous cesarean birth and no other risk factors in a large, tertiary maternity hospital in England.



Implementation of midwife-led antenatal care for women with one previous cesarean offers a safe and effective alternative to traditional obstetrician-led antenatal care, and is associated with increased rates of intended and actual VBAC.

Tongue Tie and the Newborn Baby

Abby BlockComment

Since I have been training to become a Certified Breastfeeding Counselor, I've been thinking about and learning a great deal about breastfeeding - more than I had ever imagined. Something that comes up quire frequently with many new mothers is the challenge of breastfeeding. At a certain point, once you begin to hear of so many stories of difficulty breastfeeding, and depending on how much detail you hear in these stories - you may start to hear of tongue ties, lip ties, and the procedures done in attempt to remedy these situations. Why, if breastfeeding is supposed to be so natural and necessary for the survival of our species, are so many humans struggling with it? There are MANU reasons. One of the many possible reasons might be folic acid vs. folate. Read on in this article to learn more...

Tongue Tie and Breastfeeding, By Dr. Wilson

Premature Birth & Air Quality: New Findings

Abby BlockComment

This is heartbreaking. As if there are enough terrible effects on our environment and our health... now we are (not surprisingly) learning about the consequences of air pollution on newborn infants and what it costs our economy. It's obviously not just a financial issue. This affects all of us and our futures.

Advanced Maternal Age

Abby BlockComment

What does this mean? In the U.S., women who are 35 years and over who are giving birth are considered "Advanced Maternal Age" (AMA). According to the research, only about 15% of women who are giving birth are 35 years are older, however it's hard not to believe that rings true in NYC. I would estimate that about 1/3 of my clients could be categorized as AMA. The important thing to know about this, if you are 35 or over, is that your care provider may apply different policies to you than if you were under 35. Please read this very important article from Evidence Based Birth by Rebekkah Dekker, Mimi Niles, and Alicia Breaky for some well-rearched info on what AMA means in pregnancy:

The Evidence on Advanced Maternal Age

Essential Oils in Pregnancy, Birth, and for Your Baby

Abby BlockComment

I recently attended a workshop on Essential Oils in Pregnancy and Birth. Big inhale, exhale... there are some great scents that can be used for a variety of ailments, concerns, and comforts. Some are quite powerful! So, what's the right way to use them? Read on for some more info.


How to Avoid an Episiotomy in Birth

Abby BlockComment

I have not yet met a woman who does not want to avoid an episiotomy in birth!! Read on below to get some tips on how to avoid this unwanted procedure, published by Choices in Childbirth.

FEBRUARY 16, 2016


“How can I avoid an episiotomy during birth?”

Today an episiotomy is no longer a routine procedure – thank goodness – but is performed for cause. Some reasons include a tight perineum which prevents the baby’s head from distending the perineum, prior scarring of the perineum, female circumcision, and/or the baby’s heart beat is low and delivery needs to be expedited. We can decrease the problems with the perineum but not some of the other causes.

The other question is how to prevent natural tears of the vagina and the perineum. It is important for women to know that there is a group of muscles in the vagina that support the vagina, bladder and rectum. These muscles need to be strengthened and toned prenatally to increase their elasticity to allow for relaxation of the vagina and perineum during birth. These same muscles need continued exercise for the remainder of our lives. Thank Dr. Kegel for giving us the Kegel exercise!!

Proper overall fitness is important so consider walking and squats for toning. Proper nutrition is also key. Make sure that you get adequate protein and other nutrients for your tissues to respond well to the stretching of birth.

Keeping the vagina healthy and reporting any signs of an infection to your provider promptly to maintain good vaginal tissue integrity is hugely important. Perineal massage is advocated by many to be helpful in preparing the vagina and the vaginal muscles for birth. This needs to be initiated at 34 weeks and done for approximately 5 minutes 3-4 times per week.

When it comes time to push, your position is important, as is the use of warm compresses on the perineum. The lateral position or squatting for birth is protective of the perineum.

Finally, a slow, controlled delivery of your baby’s head will definitely help to decrease tears. This is difficult when you have a very strong urge to push. I recommend practicing techniques learned in childbirth classes such as focused relaxation.


Susan Papera, CNM,MSN received her undergraduate degree from Cornell University and her Master’s degree and Midwifery from Columbia University. She joined the staff at NYC Health + Hospitals/North Central Bronx as a staff midwife shortly after the Obstetrical services were open in 1978 and she has been helping to care for the women and families in the Norwood section of the Bronx ever since. Presently, she is Director of Midwifery Services. Working with such a richly diverse group of women is extremely rewarding and also an on going learning process as she says. Ms Papera is particularly proud of the fact that she is an NCB “Grandmother”- babies she has helped into the world are returning and she has had the privilege of helping their babies into the world.


Abby BlockComment

Seriously! As a doula, I support my clients' personal choices. Only each woman can know what is right for her when it comes to choosing a birth location, a care provider, and what type of care she would like to receive. There are so many different ways to give birth, which is wonderful, because there are so many kinds of women!

I love this quote from this recent article that explains some of the current controversy going on in the birth world:

How and where and whether someone has a baby is, by and large, every bit as personal as the business that led to conception in the first place.

Isn't that the truth?

Read the full article here.

Exercise & Pregnancy: Surprising Benefits!

Abby BlockComment

So many benefits! More than you think. Here's one:

But now a growing body of research — mostly done on rodents — is revealing just how beneficial it is for the offspring when their mothers exercise during pregnancy. In 2014 researchers at Dartmouth College revealed that exercise during pregnancy enhances brain function in offspring, and that this boost to the brain continues into adulthood. In 2015 a team at the Washington University School of Medicine found that exercise in pregnancy lowers the risk of heart defects in offspring.

Read the full article here.

Things you can stop worrying about in pregnancy!

Abby BlockComment

Great article here! You have enough to worry about it as is, so check out this article to help you let go of some of those things that may have been weighing on your pregnant mind . . .

October 23, 2015, published on Mind Body Green

As a family doctor specializing in obstetrics, a midwife for 25 years, and the mama of four grown kids, I know firsthand what women go through during the precious nine months of pregnancy. And if there’s one universal emotion I’ve seen, it’s worry. 

Worry is a normal response to the uncertainties of pregnancy, as well as to caring deeply about our babies. And there are a lot of legit things to be concerned about, like the health effects of the chemicals in our cosmetics and the antibiotics in our foods. 

The truth is, most babies are born healthy and perfect. And when there is a problem, it’s just not your fault.

But here's the thing: While we should definitely pay attention to the risks we can avoid — and make the most educated choices we can — worry itself doesn't usually help. In fact, it tends to make us lose sleep and feel overwhelmed, and can even affect stress hormones in ways that affect pregnancy and labor. 

So, to encourage you to step away from the stress, here's a list of 11 things you definitely don't have to worry about during your pregnancy: 

1. Harming your baby.

I find that the most common fear is that we’re going to do something that harms our baby. The truth is that most congenital problems are a result of genetics or an environmental exposure that we didn’t even know about or had no control over. 

If you’re reading this, my guess is you’re already a health-conscious adult and aren’t regularly engaged in activities that can harm baby, like drinking excessively or using cocaine. 

The truth is, most babies are born healthy and perfect. And when there is a problem, it’s just not your fault. Period. 

2. Eating for two.

The idea that we have to "eat for two" in pregnancy is a flat-out myth — and one that has encouraged women to both suspend good dietary habits and worry about whether they're getting enough. 

The truth is that during the first and second trimesters, you don’t need any more calories than usual. And by the third trimester you only need 300more calories a day (double that if you’re pregnant with twins). That's the equivalent of just a glass of milk and half a sandwich. 

So if you're eating an overall healthy diet, let go of the worry that you’re not eating enough for baby. 

3. Having sex during pregnancy. 

Having sex while you're pregnant doesn't usually cause miscarriage or preterm labor. The only precaution? Making sure your sexual partner doesn't have any diseases that could be passed on to the baby. 

But if you're having symptoms of miscarriage, preterm labor, or have what's called placenta previa, that’s a different story — follow the “nothing goes in the vagina” rule until your midwife or doctor clears you. 

4. Eating foods that could give your baby allergies.

A lot of food-conscious mamas avoid dairy, gluten, nuts, and soy during pregnancy, worrying about how it will affect their baby. But while nutrition is super-important, restricting foods during pregnancy has not been found to prevent allergies. In fact, it may even increase risk

So unless you have to restrict certain foods for your own health, liberating your diet can actually be beneficial to your baby. Keep it healthy, but don’t restrict. 

5. Sleeping on your back.

You’ve probably heard that you shouldn’t sleep on your back during pregnancy because it can cut off oxygen to your baby — and that might be leading to a lot of uncomfortable nights on your side. 

But until you’re six months pregnant, this isn't something to be concerned about. After six months, the weight of the baby and your uterus can cause pressure on a large vein called the inferior vena cava, restricting blood flow to you and baby. 

However, if you find that you’ve rolled over onto your back during the night, don’t worry! It’s very unlikely that this would cause harm to baby. 

6. Stress during pregnancy.

You might have heard that a mom being stressed during pregnancy can affect the baby’s long-term mental health. The irony is that this very information is what gets pregnant mamas all stressed out! 

The truth is that you’d have to be under a lot of stress (we’re talking war zones or violent homes) for stress to have a serious impact on your baby’s health. 

The normal stresses most of us experience daily — money worries, relationship tensions, and job anxieties — are not going to cause your baby to have three heads or lifelong depression. As a species, we’ve given birth to healthy offspring under much worse threats. 

You can’t force a homebirth, vaginal birth, unmedicated birth, or a perfect story. And worrying about it is not going to get you there.

7. Being a vegan or vegetarian. 

No, you don’t have to eat meat and dairy — you can be vegan or vegetarian and have a perfectly healthy pregnancy. In fact, I was vegetarian for three of my four pregnancies. 

Just make sure your diet includes plenty of vegetarian protein sources(legumes, beans, nuts, and seeds), calcium (organic tofu, almonds, tahini, and green leafy veggies), and iron (legumes, green veggies, red beans, dried apricots, and raisins). And if you're vegan, make sure to take a B-12 supplement. 

Work with your midwife or an integrative nutritionist who is pregnancy-savvy to make sure you’re meeting your prenatal nutritional needs. 

8. Normal pregnancy symptoms.

Pregnancy brings with it some quirky symptoms, including nausea, increased urination, round ligament pain, breast tenderness, changes in your sense of smell and taste, sleep disturbances, mood changes, and many more. Knowing what’s normal — and what’s not — can make a huge difference in letting go of unnecessary worries. 

There aren’t too many symptoms to worry about, so make sure to talk with your midwife or doctor about those. You can also learn about natural solutions for common symptoms in my book, The Natural Pregnancy Book

9. What labor will be like.

Labor can't be controlled. All you can do is set a destination on your GPS, prepare well for the journey, and then move gracefully through any obstacles on the way. 

You can’t force a homebirth, vaginal birth, unmedicated birth, or a perfect story. And worrying about it is not going to get you there. 

The best thing you can do is prepare for labor. Take childbirth classes and read books that are supporting of the kind of birth you hope to have. (I recommend Spiritual Midwifery and Birthing From Within to start.) You can also take a hypnobirthing class to give you mind-body skills that can help.

If something comes up that requires you to reroute your plans — for example, a medical reason to have a cesarean — it’s totally appropriate to grieve. But be gentle with yourself and just make sure you’re in good hands. It’s all good. 

10. Dying.

OK, truth be told, the most common fear that women experience is probably fear of death — our own, our baby’s, or our partner's. 

Fear of our own death stems from the intense uncertainty of the process of birth, compounded by the historical risks, magnified by movies in which birth is depicted as dangerous and even life-threatening. That can make birth feel really terrifying. 

The reality is that there is an infinitesimally low for healthy women in the U.S. There's also a very low infant mortality rate

Remind yourself that it’s normal to have such thoughts. And then have an affirmation or meditation you can use to transform the fear. Talk your worries out loud with your midwife or other women, or write them down in a journal. If you're severely plagued by worry or anxiety, it's important to talk to a prenatal mental health professional. 

11. What other people think.

The hard fact is that women can be really judgmental with one another around pregnancy and parenthood choices. 

I’ve had many wonderful women tell me they were kicked out of natural mom online groups because they had an epidural or needed a C-section. My response? What other people think is not your worry. 

How you do your pregnancy, birth, and parenting is your business alone. If you’re worrying about what other people think, please, stop right now — because it will keep you from making the choices that are best for you and your baby. 

And when you make the choices that are right for you, your family and friends will get on board, and you’ll find the right mommy groups for yourself too!