In our prenatal and postnatal classes over the last few weeks there has been much discussion on the COVID 19 vaccine. At Pippagina we represent women from all over the world, and the vaccine program varies from country to country. In this blog I have summarised the findings from the World Health Organisation(WHO), and Joint Committee on vaccination and Immunisation(JCVI); with reference to recommendations from The Royal College of Obstetrics and Gynaecology (UK), The Royal College of Midwives (UK); and The Centre for Disease and Control (USA). At the end of this article I have provided links for further reading. Coronavirus and pregnancy The risk to pregnant women and newborn babies following coronavirus infection is generally low. However, pregnant women are more likely to have severe coronavirus (COVID-19) infection if they have underlying health conditions such as:

  • Diabetes, high blood pressure or asthma

  • Are overweight

  • Come from a Black or Asian Minority Ethnic background

  • Over the age of 35 years. It has been shown that if you contract coronavirus with symptoms in pregnancy, then you have an increased chance that your baby will be born prematurely. The latest advice from the Joint Committee on Vaccination and Immunisation (JCVI) states that the COVID-19 vaccines should be offered to pregnant women at the same time as the rest of the population, based on the woman’s age and her clinical risk group, (Royal college of Obstetricans and Gynaecology. April 23rd 2021). The coronavirus vaccine can be given at any stage during pregnancy. Some women may choose to delay their vaccine until after the first 12 weeks (as the first trimester is the most important for the baby’s development); and plan to have the first dose at any time from 13 weeks onwards. As COVID-19 has more serious complications in later pregnancy, with a higher risk of the baby being born prematurely, women may wish to have the vaccine before their third trimester commences. Does it matter which vaccine I have? As with most medicines and vaccines, large clinical trials need to be carried out to ensure its safety. Although there is limited data on the coronavirus vaccines in pregnancy, available data does not indicate any harm to the pregnancy. The latest information from JCVI advice published on 16 April 2021 advises that it is preferable for pregnant women to be offered the Pfizer-BioNTech or Moderna mRNA vaccines, where available. In the USA, around 90,000 pregnant women have been vaccinated mainly with Pfizer and Moderna vaccines and no safety concerns have been identified. Evidence on COVID-19 vaccines is being continuously reviewed by the World Health Organization and the regulatory bodies in the UK, USA, Canada and Europe. Pfizer and Moderna vaccines are the preferred vaccines for pregnant women of any age who are coming for their first dose. Anyone who has already started the vaccination program and is offered a second dose whilst pregnant, should have a second dose with the same vaccine unless they had a serious side effect after the first dose.


Breastfeeding and COVID Vaccine The benefits of breastfeeding are well known. Clinical trials on the use of coronavirus vaccines while breastfeeding are not advanced. However, the available data do not indicate any harm to the breastfed infant and the Royal College of Obstetrics and Gynaecology state that new mothers do not need to stop breastfeeding in order to be vaccinated. In line with recommendations from the World Health Organization (WHO), the Joint Committee on Vaccination and Immunisation (JCVI) has recommended that any suitable coronavirus vaccine can be given to women who are breastfeeding. As with the Covid vaccine and pregnancy, the current recommendation from JCVI is for breastfeeding women to be offered the vaccination at the time when they become eligible. Below you will find further information discussing the risks and benefits of the coronavirus vaccine written by the experts. It is advisable to read and if you have further questions make sure you speak to a clinician before being vaccinated. References and further reading

  1. https://www.who.int/publications/m/item/safety-surveillance-of-covid-19-vaccines-in-pregnant- and-breastfeeding-women

  2. https://www.rcog.org.uk/globalassets/documents/guidelines/2021-02-24-combined-info-sheet- and-decision-aid.pdf

  3. https://www.gov.uk/government/publications/covid-19-vaccination-women-of-childbearing-age- currently-pregnant-planning-a-pregnancy-or-breastfeeding/covid-19-vaccination-a-guide-for- women-of-childbearing-age-pregnant-planning-a-pregnancy-or-breastfeeding

  4. https://www.rcm.org.uk/guidance-for-pregnant-women/

  5. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/recommendations/pregnancy.html




I have been an Ex Pat for almost 20 Years .First living in America and now Germany. Each move was in pursuit of my husbands career. Therefore I never cease to be impressed when I meet women in a similar situation to me, who have had to discover a new career path when moving countries.


These blogs spotlight the women that have turned their talents to creating opportunities for both themselves and the communities they serve. This blog series will help educate, inform and inspire but above all, it will help celebrate the strengths of women who can (and do!).


SPOTLIGHT ONE

Amanda Isaac- Post Baby Restore Program

Amanda, what brought you to Munich, Germany? I moved to Munich over five years ago with my Italian husband. Our first baby was just five weeks old at the time. Initially the move was temporary but plans changed and when I realised I would never return to my 10 year long nursing career in Quebec, I was determined to find a way to reimagine my skills. So, you are a qualified nurse? Yes! I am a nursing graduate from University of Ottawa. My first two years were spent on a post-partum ward helping new mothers. I then spent many years in clinical work with community health and maternal childcare in remote northern communities of the James Bay, Quebec. I am very passionate about my work, so it was very hard to accept that I would have to leave that behind. How have and built on those skills since? My principle interest has always been supporting the health and wellness of women. Pregnancy and motherhood pushes women through massive changes to their body. It changes your posture, weakens joints, stresses the pelvic floor, interrupts diaphragmatic breathing and damages and weakens core muscles. From my personal experience as a nurse and as a sportswoman, I saw there was a way I could forge a new career to help new mothers regain their core strength post-delivery and make them feel better in their post baby body. Having always been an athlete growing up and wanting to be able to help people, it felt like the right fit. Initially I took an intense personal training certificate program with the American College of Sports Medicine. I am about to complete my studies with recognised international physical therapist Dr Sarah Duvall as a Pregnancy and Postpartum Corrective Specialist. This training and my own success in correcting the physical problems faced in the postnatal period has been the bedrock of my new career. Tell me more about how you can help mothers regain their optimal health and wellbeing? I created the Post-Baby Core Restore programme. It’s a series of app-based workouts designed to correct issues such as recti diastasis or the separation of the abdominal muscles during pregnancy, to resolve pelvic floor dysfunction and fix those embarrassing leaks, restore good posture and deep diaphragmatic breathing and regain core strength. It’s a six-week programme. None of the 24 workouts need any special equipment and can be worked into any schedule. I resolved my own postpartum issues with this programme and I am so proud to have helped so many women regain their confidence and health. Amanda’s Post-Baby Core Restore programme can be purchased at www.amandaisaaccoaching.com and is currently available for the special price of 49Euros (instead of 89Euros). Once purchased the programme is available for 12 weeks. For any questions please contact Amanda on info@amandaisaaccoaching.com

Amanda speaks fluent English and French






SPOTLIGHT TWO

Jennelle Liljestrand

Licensed Independent Clinical Social Worker

Heilpraktikerin for Psychotherapy

Professional Certified Coach


Jennelle, give me a super short description of your background.

I was raised in a wealthy suburb of Boston in the USA. I developed an interest in psychology during college and graduated with a Psychology degree from Bates State College which led me to a Masters in Clinical Social Work from Smith School for Social Work. It was a powerful program that gave me a set of incredible tools to help clients by being totally non-judgmental and utterly present, in order to deliver the perfect therapy for individuals, couples and groups. As part of my Masters programm I worked for a year in a Hospice and a further year with veterans of the Vietnam and Iraq wars. After completing my Masters I worked at Brigham and Women’s Hospital in Boston offering individual and group therapy.

How did you come to have your own practice in Munich?

I moved to Munich with my husband in 2014. I was committed to pursuing my career and after completing an intense German course, I started initially working as a volunteer helping refugees and then went on to work at the Sozial Psychiatrische Dienst in Perlach, following this I worked at the Amper-Klinikum Haar for a year. I am certified as a Heilpraktiker for Psychotherapy here in Germany and also a qualified Professional Coach. In 2018 I became mother to twin girls and opened my practice offering coaching, individual therapy, couples therapy and group therapy. It seemed like the ideal next step. I am especially well placed to help the women moving to the country that find themselves unable to continue with their previous career. It’s so tough, as they experience a loss of identity and often feel a lack of purpose in their new home country.

Can your therapies help new parents?

Yes! I recognise both professionally and personally the burden of stress that so many new parents experience. Many are living away from their own families, coping with the stress of moving and adjusting to a new culture and language. Half of my work is with new parents, predominantly mothers but new fathers too. I work with mums and dads to help create a balance with work and family life. I work with lots of couples and I use the Gottman Method which is a really powerful approach that delivers a strong framework on which couples can rebuild or build a healthy and positive partnership. I also help individuals and couples cope with the loss of a pregnancy or other forms of grief.

How have you been able to help your clients during the pandemic and what challenges are they facing?

I continue to accept socially distanced appointments at the Praxis but I also offer online appointments. I’m helping individuals struggling with anxiety, depression and low self-esteem often associated with being separated from their families or unemployment. It’s tough times and I encourage anyone struggling to reach out for support.

To find out more about how Jennelle might help visit www. munichtherapy.com.


SPOTLIGHT THREE


Na'ama Rony

Acupuncturist


Na’ama, how would you best describe your area of expertise?

I was born and raised in Israel and have lived here in Germany since 2006. I am a qualified acupuncturist with over 27 years experience. My interest in acupuncture was initially personal. Traditional Western medicine focuses on and treats mostly the symptoms, ultimately suppressing the illness. Holistic medicine generally, and acupuncture specifically treats the person as a whole; both physically and mentally. Acupuncture treatment is tackling the root of illness and disease. It was an approach that made total sense to me.

Tell me more about your career journey-

I undertook a two-year long internship with a highly regarded Chinese acupuncturist in New York to really immerse myself in the discipline followed by four years in a Chinese Medicine college in Israel, where I graduated. Later on I was very fortunate to spend four years in China where my husband was working. During this time I specialized in oncology, gynaecology and pediatrics in local hospitals as well as working in an international clinic. On returning to Israel I started my clinic and I teamed up with four colleagues to create a four year degree program to teach acupuncture at the University of Tel-Aviv, this course is still running today.

So how can acupuncture help?

In many, many ways. As a holistic approach there is really no stage of life in which it can’t help. There are benefits right from the first week of life. The super fine needles are only inserted momentarily in babies or we use tiny Vaccaria seed plasters to apply pressure to the relevant acupuncture points. Acupuncture can help with gas and constipation, teething, recurrent ear and


Do you have success with treating fertility and pregnancy challenges?

Yes I do, Acupuncture can help with fertility and throughout pregnancy. I help pregnant women experiencing nausea, vomiting, constipation, migraines, joint and back pain. I help turn babies in breech and transverse positions. I can help induce a labor and importantly I can help with postnatal issues such as mastitis and blocked ducts.

A great natural solution to so many challenges, anything else?

As I said, acupuncture works in every stage of life and so when women reach menopause it helps here too: with hormonal changes, hot flushes, headaches, constipation, mood changes, depression and insomnia. A truly holistic approach.

Languages- English and Hebrew.

Na’ama can be contact by email naamarony@gmail.com, or by phone 017651437619 and has a practice in Dachau.




Home birth is defined as giving birth to a baby in your place of residence. Most home births are attended by a Hebamme/midwife, though they can be attended by a doctor; and in an unplanned home birth this may be attended by emergency technicians, or in a very quick birth it may be a family member in attendance. In most countries it is not legal to have a planned home birth without medical personal in attendance In a low risk pregnancy there is evidence to suggest that a home birth can be as safe as a hospital birth; especially when it is not the mother’s first pregnancy. A home birth is associated with reduced intervention, and an increased normal delivery rate. Overall the literature shows that a woman experiences less pain when in her own environment, has more autonomy over her birth and increased satisfaction. Another advantage of a home birth is the continuity of care that a woman and her partner receive. They are cared for in a small team of midwives which means that for the most part they will have already met the midwife who is with them at their baby’s birth. The percentage of home deliveries has only decreased over the years with numbers in the UK and Germany being around 1% per of all births. Most women in Munich choose to deliver in a hospital or birth house (Geburtshaus) but for those who wish a home birth there are Hebammes in Munich who offer this service. As a student midwife I had the privilege to attend a few home births and in my early days as a midwife I worked in a team of midwives where home birth was offered. It has been many a year since I have been present at a home birth, but at a recent "fortbildung" class in Munich I met Julia, a Hebamme who specialises in home births here in Munich I spoke with Hebamme Julia about her Praxis here in Munich.


Let’s pitch straight in…why did you choose to become a midwife?

My Godmother told me when I was young that I have ‘midwifes hands’ but as a career the idea grew on me quite slowly. I became interested in feminist politics, women’s rights and women’s health when I was still in school and so when I was looking for a career I realised that it would be incredibly powerful to support women through what is always a special time in their lives. It would be a way to assist women as they develop their family and help them as they bring new life into the world.

I understand you studied midwifery in the UK not in Germany, why was that?

Right from the start I knew that I wanted to be a community-based midwife. At the time you couldn’t do a degree in Germany but in the UK I was able to study at Plymouth University and do my community based training in Devon and Cornwall. As a rural area Devon and Cornwall had a home birth rate that was slightly above the national average. I was so fortunate to secure a community post with a group of very experienced midwives. I also valued the complex ways in which UK midwives are taught to assess medical evidence, the training is rigorous and there is greater autonomy as a practitioner. I was there for three years and I loved it.

Congratulations on starting your new practice in Munich. Tell me more about it.

Thank you. I launched in April 2020 which was a crazy time to start but actually, it’s worked so well. I offer one-to-one care for pregnant women that are looking for home birth support. It’s a very bespoke approach and I am with my client through the whole pregnancy and beyond through to the newborn’s early months. Pregnancy and birth is a truly natural unfolding of a beautiful experience in a woman’s life. I walk that path with my clients. Planning a home birth is so empowering. It means that the pregnant person and family around them can take full responsibility for their care and birth experience.

What are the key benefits of a home birth?

A woman has total control over an environment that she is already comfortable in. Her birth partner or partners can be with her continuously from the first contraction to the birth and beyond. There is a sense of ‘doing something’ when you go into hospital or ‘having something done’...at home that doesn’t happen, it’s just an organic process. During home birth the rate of unnecessary intervention is lower than in a hospital setting while mother and baby are just as safe. In Germany numbers on safety of out-of-hospital-births have been collected since 1999 and can be accessed via this link.. One-on-one care is a real benefit to the birth process too.

How do you tackle any clinical concerns during pregnancy or labour?

The client and I are well prepared. Any clinical concerns are factored into the situation ahead of time and discussed with everybody involved, including a discussion on whether home birth is the right choice if there are any clinical concerns. If a situation develops beyond the range of normal physiology in pregnancy, I refer to the gynaecologist or hospital as appropriate. I am of course trained to deal with any arising emergency situations.”

To find out more about how Julia can support you through a home birth go to www.julia-preu.net or email julia.preu @ riseup.net


1
2

WELCOME TO THE PIPPAGINA BLOG