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Parenting is a special journey. After all, not everyone will have the chance to raise little human beings into full-grown ones. It’s definitely a responsibility that should not be taken lightly, so here's a guide to help you, parents, navigate the nuances of this world, so you can successfully nurture your little ones through every age and stage of their precious lives.
 
Health and Fitness
A focus on nutrition, exercise, and sleep will ensure that your kids remain strong and healthy.
 
9 Must-Eat Nutrients for Your Child
Best Ways to Help Children Fall Asleep at Nap Time
 
Mental Health
Keeping up with your children’s mental health ensures that they grow up to be kind, empathic, and productive.
 
Recognizing Mental Health Problems in Children
Adolescent Depression: What Parents Can Do to Help
 
Intellectual Development
Keeping up your kids’ brain development by keeping them engaged and challenged is vital in helping them reach their full potential.
 
Encourage Learning with Puzzles
How to Help Your Teen Develop Good Study Habits
 
Safety and Security
Educating your kids will equip them against the world’s many dangers because you won’t always be around to protect them.
 
Safety Hazards to Watch for Around the House
Teach ‘Stranger Danger’ in 4 Easy Steps
 
Self-Care for Yourself
While you may want to save every ounce of energy you have for your children, you need to budget some time for yourself and your interests as well.
 
Make Time for Yourself: A Self-Care Guide for Busy Parents
Use a Free Resume Builder to Help Land a Job You’re Happier With
Ensure You Establish and Maintain a Healthy Work-Life Balance
Working Parents, Save Time for Hobbies
 
When raising children, you really do have to be prepared to roll with the punches and change your methods as they grow. Parenting is a journey, after all, and one that’s rife with challenges in more ways than one. However, in exchange, you do get to enjoy the company of little humans and watch them grow. That, in itself, is the reward right there.
 
Photo via Pexels
Article courtesy of Daisy Jones
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Teton Women’s Health Center offers services ranging from clinic visits and office procedures to hospital management of our patients with antepartum care, deliveries, surgeries and acute gynecological care at both Mountain View Hospital and Eastern Idaho Regional Medical Center. Reach out for more info today! 208-523-2060

The Life of a Single Mom is committed to seeing no single mom walk alone. Connect with us to find out more! 225-341-8055

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Image from Unsplash
Blog courtesy of Elena Stewart

Have you been going through a phase of stagnancy? Perhaps your mid-life or quarter-life crisis is just hitting. Either way, sometimes we just need a little push towards betterment and improvement. At Teton Women’s Health Center we believe that small habits amount to significant change. In the guide below, we share essential transformative practices that will help you improve your life and level up your wellness in a big way. Let’s get into it.
 
Level up Your Sleep 
Yes, everyone knows that sleep is critical to improving your life. But this one has been touted for centuries because it really works! The Sleep Foundation recommends that women get between 7-9 hours of sleep each night, which is an excellent place to start. Once you’ve started getting enough sleep, why not improve your sleep experience too? If you’ve been using an old hand-me-down mattress or cheap bedding, splurging on well-formulated sleep essentials will be the way to go. Soft sheets, fluffy pillows, and a well-made bed can make all the difference too. Bonus: add a night-time routine to induce better quality sleep. Have a long shower, light a candle, meditate, read a book - all these pre-bedtime activities can reduce the chances of insomnia and induce a deeper sleep.
 
Level up on Social Media 
You know what they say - comparison is the thief of joy. While social media is vital for keeping in touch with friends and news, it can also negatively affect our well-being. The ‘doomscrolling’ symptom is common amongst women especially - where the urge to keep scrolling leads to comparison and negativity. Try to implement social media hygiene into your life - for example, not browsing before bed or after you wake or limiting usage to just an hour or so every day. While it may feel weird not to pick up your phone and look through social media every couple of minutes, you’ll find your mind clearer and more mindful in the long run.
 
Level up by Making Lists 
List-making has been proven to help with organization and mental health. If you find yourself all over the place, forgetting things, and feeling scatter-brained: this activity is the one for you. Just open your notes app and list things down - from groceries and to-dos to solutions for problems and things you can do while bored. Making lists is an excellent way to gain back control of your life and seize ownership over everyday experiences.
 
Level up by Getting Regular Checks 
EverydayHealth writes that medical tests such as mammograms, cholesterol screenings, and pap smears are essential to every woman’s health. Be sure also to visit a clinic like Teton’s Women Health Center for regular obstetrical and gynecologic checks and healthcare. By investing in your health, you’re committing to feeling good and improving your life from the inside out.
 
Level up Your Career 
Education is the ideal way to boost your career prospects and earning potential. But if you’re a lady on the go, you likely don’t have time to commute to school and commit to classes every day. Earning a degree online is the perfect alternative, as you’ll be able to continue working or tending to family obligations - all while improving your educational qualifications! And you’ll have the opportunity to make a career switch too. For example, a degree in information technology will foster learning in networks, IT foundations, cloud foundations, and more, which you can apply in a wide range of industries. When looking for an online school, ensure it is accredited and offers competitive tuition rates.
 
At the end of the day, living a better life is all about change. To achieve growth and self-improvement, you will have to adopt a fresh mindset, positive attitude, and helpful habits. The good news is that by doing so, you’re setting yourself up for a drastically improved quality of life! So get out there and level up on your life today.
 
Enjoyed this article? Be sure to check out the Teton Women’s Health Center for more informative content today.

Image via Pexels
Blog Courtesy of Daisy Jones

If you carry a gene for a genetic disorder that increases your risk of passing a disease, birth defect, or developmental condition onto your unborn child, you may have some concerns about having a baby until you’ve explored all your different options. For instance, you may wish to meet with a genetic counselor and undergo genetic testing before or during pregnancy — especially if inherited diseases run in your family or you belong to an ethnic group where genetic risks are more prevalent.
 
The following advice presented by Teton Women’s Health Center will help you to plan for pregnancy if inherited conditions run in your family, so read on to learn more about genetic counseling, testing, and the types of disorders that can be passed down from parent to child. 
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Gather Family History InformationGathering information about your family health history is one of the first steps you should take if you’re thinking of having a baby, as a family history of genetic diseases, birth defects, or developmental disabilities could increase your risk of passing these conditions onto your child. MedicineNet notes that some examples of genetic conditions that can be passed down from parent to child include:

• Birth defects such as cleft lip, heart defects, and hearing loss.
• Genetic disorders and syndromes such as Marfan syndrome, Prader-Willi Syndrome (PWS), Down syndrome, Williams syndrome, Fragile X, Smith-Magenis, Angelman, Smith-Lemli-Opitz syndrome (SLOS), Lesch-Nyhan, Cornelia de Lange, Rhett syndrome, Cri-du-chat syndrome, Tay-Sachs, and Sotos syndrome.
• Other health conditions such as sickle cell disease, cystic fibrosis (CD), spinal muscular atrophy (SMA), thalassemias, and hemoglobinopathies.

 
After gathering your family health history, share this information with your doctor and follow his or her recommendations as closely as possible. Recommendations may include genetic counseling, genetic testing, dietary and lifestyle changes, and pre-conception supplementation.

Meet With a Genetic CounselorIf your medical doctor refers you to a genetic counselor, this type of professional can help you to understand your genetic risks — including your chances of passing an inherited condition onto your baby. A genetic counselor can also help you to determine whether genetic testing is right for you.
 
Parents magazine explains that genetic testing can be used to screen for diseases and conditions such as cystic fibrosis, Fragile X syndrome, blood disorders, Tay-Sachs, and spinal muscular atrophy. Health insurance sometimes covers the cost of genetic testing when your doctor refers you, so be sure to check with your carrier.
Plan for BabyOnce you’ve gathered your family history information and completed genetic counseling and/or genetic testing, you may be ready to start planning for your baby. As mentioned above, follow your doctor’s recommendations to protect yourself and your unborn baby — and start preparing your family’s finances. Additionally, you may also want to discuss leave benefits associated with the Family and Medical Leave Act.
 
As part of your pre-pregnancy financial planning, you might also choose to move to a larger home for your growing family — and maybe even save for a down payment on a house. Saving for a down payment takes time and budgeting, however, so it’s important to make changes to your spending, pick up extra work when possible, and check your credit early on in the process so you’ll have plenty of time to improve your credit score before applying for a mortgage.
 
If you plan on applying for a home loan in the near future, be sure to shop around for mortgages and compare loan types and rates. PennyMac USA is one type of mortgage lender to consider,  as conventional, VA, and FHA loans are available to those who qualify. Other mortgage lenders include Quicken Loans, U.S. Bank, Wells Fargo, and Guild Mortgage. Local options include Bank of Idaho, Bank of Commerce, Idaho Central Credit Union and Zions Bank, among others.  You may also wish to look into state-specific programs for first-time homebuyers, depending on where you live.
 
You’ll be spending a lot more time at home with the new addition to the family, so you may want to consider making a career transition so that you’re able to work from home. This may even involve starting a home-based business. If so, this will require setting up a home office and getting what you need on the technology front, such as whatever hardware and software you may need. There are a lot of free tools available that can help you keep costs down. For example, you’ll want to come up with a catchy logo, and it’s possible to design one for free with an online business logo creator. This saves you money by not having to hire a graphic design pro.

The Bottom LineHaving a baby is a huge decision, and it’s one that takes careful planning and consideration — especially if genetic conditions such as Marfan syndrome, Fragile X, or cystic fibrosis run in your family. By considering your family medical history, meeting with a genetic counselor, and making a few healthy changes before getting pregnant, you’ll reduce your risk of passing a genetic disorder or disease onto your baby — and ensure your little one will live a happy, healthy life.
 
Services at Teton Women’s Health Center range from clinic visits and office procedures to hospital management of our patients with antepartum care, deliveries, surgeries and acute gynecological care at both Mountain View Hospital and Eastern Idaho Regional Medical Center. Contact us today for more info! 208-523-2060

As a woman, no matter what stage of life you’re in, you always want to look and feel your best, whether at work or for a night out on the town. Maybe you’re trying to spruce up your wardrobe, to have more energy to do what you love, or you’re striving to bring more joy to your life. Whatever you’re after, we have some tips just for you:
 
Wear Clothes That Flatter Your Body
 
Much of our physical characteristics are defined by our genetic makeup, so instead of wishing for a different body type than the one you inherited at birth to fit the clothes you like, choose clothes that fit well and flatter the body you have. You’ll feel much more comfortable in your own skin, and you’ll be able to highlight your most attractive features by selecting the right piece of clothing: sleeveless tops to accentuate your arms, wide-legged trousers to balance broader shoulders, or V-necks to elongate your torso. So pick up a few flattering pieces and go from day to night in style.
 
Add Accessories that Make You Sparkle
 
The right accessory can brighten up or update any outfit and make you feel like a million bucks. Adding a belt to your dress or suit can help define your waistline; a pretty scarf around your neck can bring a touch of whimsy to what you're wearing. And don’t forget to include jewelry to complete your look as you get ready for the day. Tiger’s eye jewelry is a timeless classic that can effortlessly bring an outfit together. Some believe that this golden to red-brown gemstone has healing properties for the body, the mind, and the soul, and that it can even eliminate negative energy; so wear it as a bracelet, a pendant, or earrings and experience its benefits for yourself.
 
Make Exercise a Part of Your Day
 
Whether you get up early in the morning and go for a jog around the neighborhood or you use part of your lunch hour to hit the gym and do some cardio, getting some exercise is not just good for your body, it’s also great for your mind. Studies have shown that moderate aerobic exercise for 30 minutes a day helps lower your blood pressure while improving your levels of good cholesterol. It can also prevent bone loss which leads to osteoporosis, and it’s great for relieving tension and stress. So don’t skip your workout routine, and keep your energy levels up throughout the day.
 
Keep Your Face Radiant
 
To keep your face looking young and healthy, use a facial cleanser morning and night to get rid of dirt, oil and impurities. As part of your morning routine, apply a broad-spectrum sunscreen before getting out the door to prevent sun damage and skin cancer, even in the winter months. At night, try not to skip your regular skincare protocol, even if you’re tired. Take time to remove your makeup and cleanse your face as it’s been exposed to grime and outdoor pollutants during the day. Using an ultra-moisturizing night cream will nourish and brighten your skin as well as help reduce the appearance of wrinkles while you sleep. After a good night’s rest, you’ll be ready to face a new day with radiant skin.
 
Looking your best isn’t just for the people around you; it’s a great way to feel good about yourself and improve your self-esteem. So pick a wardrobe that flatters your body, add a few accessories to set you apart, and get ready to shine.
 
From pre-conceptual counseling to delivery, tetonobgyn.com is there for you every “baby” step of the way! Call our office at 208-523-2060 to schedule an appointment.
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Image via Pixabay
 
 Guest post by Elena Stewart

 A Rexburg couple had Christmas come early this year, in the form of identical triplet girls.

​Olivia and Connor Gressel welcomed Lina, Jane, and Marceline (Marcy) on December 20, more than two months ahead of their original due date of February 27.

The girls are the first-ever set of triplets born at Mountain View Hospital in Idaho Falls, but that's not the only thing that sets them apart.

Olivia's doctor, OBGYN Dr. Pamela Denson says that the odds of getting pregnant with triplets in the first place is about 1 in 5,000, and that's with the help of fertility treatments like IVF. Olivia also had an IUD and multiples don't run in either her's or Connor's families. This makes the girls extremely rare mono tri triplets.

"They each share the same placenta, but they're each in their own individual sac," Denson said. "I mean, the chance of that is about 1 in 100,000 in itself. And then add the chance of getting pregnant just with an IUD. I mean, it's kind of crazy. The probability of getting pregnant with mono tri triplets, where they're all sharing the same placenta and they're identical with an IUD is somewhere around 1 in 10 million. So I told her she needs to go to Vegas."
Born more than two months early, the girls are in the NICU at Mountain View Hospital, and Olivia says they're doing great.

"They're doing really good from what the doctors have told us, they're doing better than they would have expected, which is so relieving for us," Olivia and Connor said. Olivia had been seeing a specialist, as well as Dr. Denson once a week, and went in for a routine checkup Monday.

"I just mentioned it to her, 'Hey, I've just been having this pain'," Olivia said. "And she said, 'Oh, well, we should, we should check you.' And she did, and I had dilated to like a three, and she's like, 'Oh, OK, well, let's put you in the hospital because you're going to have these babies and we just want everything to be safe'. So she said, 'We'll just check you in until you have them.' And that was a huge surprise."

Doctors planned on keeping Olivia until Wednesday, but about an hour later when she was checked on again, they saw she had dilated more, and decided to perform a C-section.

Dad Connor said the girls are already developing personalities. "Jane, we thought she was kind of the more submissive one in the womb, she was getting kicked a whole time by Marcy and Lina and so we kind of assumed she was going to be the more docile one," Connor said. "And even when they came out, we saw that Marceline, she would kick really hard. And so we're like, 'Oh, yeah, she's a fighter'. She's definitely the aggressor in this case. But then one of the nurses just told us today that Jane's actually been pretty aggressive and kind of being a little feisty. So that was a little surprising because we thought she was so sweet, like 'Our Jane, are you sure?' And so we've kind of noticed a little bit of personality there. Lina has just been calm as much as you can be."

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​Credit - By Rachel Fabbi Local News 8

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**Image via Pexels

Starting a business is an exciting but challenging adventure. Add in a new baby, and this challenge can seem even more daunting. Do not let that cute little face intimidate you. You can start a successful company and still tend to your new family member if you tap into these four recommendations from Teton Women's Health Center.
 
1. Create a Schedule
While you will often do double duty as a parent and entrepreneur, creating a schedule helps you and your partner work together to maximize time. It ensures all family duties are addressed, your little one is tended to and you still have time dedicated solely to your business development.
 
Compare your two schedules, including baby duties, work, household errands, chores, and extracurriculars. Develop a family schedule that allots baby-free time for you to focus solely on your business.
 
2. Streamline Work Tasks
Finding strategic ways to streamline work projects helps your company progress faster and gives you more time to snuggle your new bundle of joy. A great example is applying for an employer identification number. An EIN is a tax ID number that the IRS uses to identify your company and track payroll taxes. Applying for one saves you time and energy down the road when you file your federal and state taxes, be it annually or quarterly.
 
Marketing is another area to streamline business procedures. Complete a thorough market research analysis to get a comprehensive understanding of your audience and their needs. Knowing this data right away helps you create effective marketing campaigns so you don't waste time and energy on unimpactful advertising.
 
A well-designed logo is essential to separate your business from the competition, build brand awareness and make a strong first impression on consumers. Instead of spending time and money hiring a design company, you should use an online logo maker to make it yourself. There are varieties of designs, fonts, and colors; you simply choose an icon, style, and text to create a unique logo. According to one report, using a signature color for your company can enhance brand recognition by 80%, so use a signature color with your logo and throughout your products, marketing, and website design.
 
3. Invest in Baby Accessories
A few quality products can put your baby at ease during the day. Not only can a white noise machine help your baby sleep better, but it also drowns out work noise, like typing, phone calls, or music. Just be sure the noise is less than 50 decibels. Otherwise, it could damage your baby's hearing.
 
Purchase a quality rocker for your little one as well. Rockers today offer loads of bells and whistles, such as vibrations, Bluetooth players, and built-in noise machines. This investment also puts your baby to sleep so you can complete items on your to-do list.
 
4. Find a Reliable Sitter
There are times when both you and your spouse have commitments and need an extra hand to help with the baby. Find a trustworthy babysitter who lives close by. Friends and family members make excellent sitters; otherwise, find a young adult in your neighborhood. Community websites often have options for parents to post about local sitter recommendations, or you can search an online babysitter directory.
 
Being proactive helps you find balance during this challenging stage of life. By making strategic choices, you can successfully launch a business while still giving your little one the love and attention he or she needs.

Article courtesy of Daisy Jones

(Photo by Pixabay)

We know that physical health is crucial, but so too is our mental health. With the stress of daily life and so many of us pressed for time, it’s difficult to find ways to enhance or implement changes to boost our mental health. Fortunately, there are several easy ways to do just that. With a little planning and an open mind, you can live your best life.
 
Set small goals
 
Many people are perfectionists to some degree, but it can be difficult to live up to our own expectations. Knowing how to set small goals and work to attain them will help you derive satisfaction, feel a sense of pride, and will keep you from feeling overwhelmed. Keeping realistic expectations is one of the keys to success, no matter what the goal is.
 
Take a new approach at work
 
Work is one of the top stressors for adults, and many Americans are dissatisfied with their jobs. Most likely, it’s not the actual work that causes unhappiness so much as how we manage our feelings and behaviors related to our job. Simple tweaks like adjusting your perspective with a monotonous task, or remembering to slow down, or even changing your work schedule slightly can make a significant impact.
 
Outsource tasks
 
Aside from work, personal responsibilities are right up there in the list of top stressors. Yes, we all have these stressors, but implementing certain hacks can reduce frustration or even eliminate unnecessary stress. For example, if you struggle with getting home to walk your dog every evening, consider hiring a dog walker. If you’re overwhelmed with making dinner every night of the week, try meal-prepping, or turn to a meal delivery service.
 
Exercise
 
Getting in daily exercise is a well-known mood booster, and it’s especially effective if you spend time outside. Soaking up the sunshine can improve positive thoughts and keep you looking forward. Remember those small goals we talked about? Well, daily movement is one of them. Make an appointment with yourself to spend at least 30 minutes every day walking, going for a run, taking a hike, bicycling or enjoying a fitness class. You’ll enjoy an improved mood and better sleep.
 
Learn to relax and focus
 
Meditation and yoga can help you learn to focus on the present moment, boost your energy levels, relieve anxiety, and learn breathing techniques that will allow you to relax just about anywhere you are. These techniques are especially helpful when you’re dealing with work or family frustrations.
 
Put work into relationships
 
Whether it’s with a significant other or a family member, working on your relationships can help you achieve happiness or closure. Have a formerly close friend you’ve lost touch with? Write a letter, or make a phone call. Keeping healthy relationships alive and well will help you feel better on a daily basis.
 
Avoid stress triggers
 
In the age of technology, when everyone has a smartphone at hand, it can be difficult to avoid stressful interactions, particularly when it comes to social media, which can be especially harmful to people who suffer from anxiety or depression.  Be sure to take care when using these modes of interaction, especially if you know it triggers uncomfortable feelings.
 
Journal
 
Not everyone is comfortable with talking about their feelings or issues, and that’s okay. Instead, start a journal and write down negative thoughts instead of venting about them to others. Relieving yourself of those thoughts will allow you to focus on the positive things in your life.
 
Go Back to School
 
Many people find completing a degree to be a good way to boost mental health. While increasing your education can certainly help you earn more money, it also keeps you focused and engaged, which is precisely the kind of mental exercise that will make you feel better about yourself.  There are plenty of online programs that work around your schedule, so it is easier than ever to start or finish a college degree.
 
We’re all navigating a crazy time in our lives, which is why devoting time to our mental well-being is so necessary. Slow down, consider these tips, and see what you can do to find calm and peace in your life.
 
 Article courtesy of Elena Stewart

The path to becoming a parent isn’t as simple for some families as it is for others. The good news is that those who can’t have children on their own now have multiple options for starting or growing their family. Surrogacy is one of those options that is becoming more popular in the U.S. This jump shows that more people than ever before are touched by the process of surrogacy in some fashion.
 
Teton Women’s Health Center offers unparalleled obstetrics and gynecological care at both Mountain View Hospital and Eastern Idaho Regional Medical Center. Call today to schedule your appointment. 208-523-2060
 
 
What is Surrogacy?
Surrogacy is a form of assisted reproduction in which a woman carries and delivers a child for the intended parents who want to start a family. There are two types of surrogacy. Traditional surrogacy is when a woman uses her own eggs to conceive for another family, meaning she would be genetically related to the baby. Gestational surrogacy (sometimes called a gestational carrier) is when a woman is not genetically related to the child she is carrying. In this case, the egg and sperm are joined through IVF, and the embryo is placed in the surrogate’s uterus. Because there are more sensitive legal issues involved when the surrogate is genetically related to the child, gestational surrogacy is far more common than traditional surrogacy.
 
What Are the Ways You Can Be Involved in Surrogacy?
 
Becoming a Surrogate
 
Some families choose to have someone they know as a surrogate, while others go through an agency. If you’re considering becoming a surrogate, an agency will start by conducting medical and psychological exams to make sure you’re a qualified candidate. When you are chosen by a family, you and the intended parents will each complete legal agreements. As part of the process, you will need to take hormonal supplements that prepare your uterus for the embryo before it is transferred. You and the intended parents will stay in close communication throughout the pregnancy.
 
Besides becoming familiar with the process, you also need to be informed about what to expect physically, emotionally, and financially as a surrogate. There are multiple financial benefits, which can include paid travel and compensation for lost wages, life insurance, and money for various other expenses. All of this compensation is in addition to the fee you receive for being a surrogate.
 
Becoming an Egg Donor
 
In some situations, the intended parent will use her own eggs or even use eggs that she has previously frozen. In other situations, though, egg donors are needed for surrogacy. This is sometimes called third-party reproduction, when the child is not genetically related to one or both intended parents.
 
Just as potential surrogates go through a screening process, you would undergo screening that includes a complete medical history. If you are chosen as an egg donor, the process involves injections that help sync your cycle with that of the gestational carrier. You can also expect ultrasounds and an office procedure to retrieve the eggs. Egg donors typically receive some financial compensation, but this can vary depending on the agency you use.
 
Becoming an Intended Parent
 
When you can’t have a baby on your own, for whatever reason, you face a big decision about which path to take to becoming a parent. If you’re new to the world of surrogacy, you probably have LOTS of questions. There are all kinds of myths about surrogacy. You may worry that the surrogate will try to take custody or that you will have a hard time bonding with your child. These myths are easily busted once you get further into researching the realities of surrogacy. Many people who are considering surrogacy also feel reassured from personal stories, like these families featured in the Dallas News.
 
As a new parent, you’ll have to plan for your baby’s arrival. This includes shopping for a stroller, car seat, and crib. You’ll also need to babyproof your home. Install gates on your stairs, secure heavy objects to prevent them from falling, and add guards to outlets and sharp corners. When you’re a new parent, it’s easy to neglect self-care, but your well-being is essential to your and your baby’s health. Before your baby’s arrival, relieve stress by decluttering your home, creating a space to exercise or meditate at home, and investing in some comfortable clothing like T-shirts and leggings to help you relax.
 
Ultimately, the decision to use surrogacy is very personal. No matter what part you play, it’s a decision to make based on what feels right for you and your family. For those who choose surrogacy, it can be extremely rewarding to be part of such a life-giving process.
 
Guest Post by Elena Stewart
Photo credit: Pexels

The COVID pandemic has had profound impact on everyone’s life last year, and pregnant women have not been an exception.  Despite living through quarantine, masking, social distancing, development of vaccination, and sometimes even experiencing COVID firsthand, the uncertainty of how COVID may affect you or a loved one may be the most stressful experience of them all.  Unfortunately, there are still unknowns about the virus and vaccination, but today’s blog will focus on what has been learned so far.
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How dangerous is COVID for women of childbearing age? 
As of writing this blog, there have been 586,659 deaths attributed to COVID in the US.  Of those, 2.7% or 15,909 have been in the age group less than 45 years old, which would be the age group including women of childbearing age.  (https://www.cdc.gov/nchs/covid19/mortality-overview.htm)

We have demographic data for age on 26 million of the cases of COVID, and of those 26 million, 64.5% of cases occurred in those 49 years old or less.  (https://covid.cdc.gov/covid-data-tracker/#demographics)  Assuming a similar distribution among the total cases of 33,292,045, that would mean 21,473,369 cases occurred in those 49 or less.  So, 15,909 divided by 21,473,369 means that the chance of dying from COVID in this age group if infected is roughly .07%  Another study looked specifically at pregnancy (https://www.bmj.com/content/370/bmj.m3320), and it showed 339 deaths from all causes in pregnant women with known COVID of 41,664 total pregnant women with known COVID.  This worked out to 0.02%  More severe COVID in this study was associated with increased maternal BMI, medical comorbidities, hypertension, diabetes and preeclampsia.  Looking at these numbers would suggest a maternal mortality risk of 0.02-0.07% from COVID, although mothers with health conditions listed above would potentially have an increased risk.

How do COVID vaccines work?
There are 3 main types being evaluated:

1. mRNA vaccines – this is the newest type of vaccine, and it works by using material (mRNA) from the COVID virus that instructs the body’s cells to make proteins specific to the virus.  After exposure to these proteins, the body creates T and B lymphocytes to fight the virus if exposed to COVID in the future.  These include the Pfizer and Moderna vaccines.  Each requires 2 injections to obtain immunity.
2. Protein subunit vaccines – these vaccines introduce a protein from the COVID virus to prompt the body to create T lymphocytes and antibodies to fight the virus if exposed in the future.  This is similar to how the Hepatitis B vaccines work and one of the pertussis (whooping cough) vaccines.
3. Vector vaccines – these vaccines use another virus modified to contain genetic material from COVID.  Once introduced into the cell, the genetic material from COVID instructs the cells to make proteins that will induce B and T lymphocytes.  Johnson and Johnson makes a vector vaccine, and it only requires one injection to obtain immunity.  Astrazenaca also makes a vector vaccine.

(https://www.cdc.gov/coronavirus/2019-ncov/vaccines/different-vaccines/how-they-work.html?s_cid=10491:how%20the%20covid%20vaccine%20works:sem.ga:p:RG:GM:gen:PTN:FY21)

Are COVID vaccines effective?
Johnson and Johnson vaccines are 66% effective at preventing COVID 19 illness in people who haven’t been exposed previously; fortunately, none of those who got COVID more than 4 weeks after vaccination were hospitalized.  (https://www.cdc.gov/coronavirus/2019-ncov/vaccines/different-vaccines/janssen.html) 

The Pfizer vaccine is purported to have 95% efficacy at preventing laboratory detected illness in those without evidence of previous infection.  (https://www.cdc.gov/coronavirus/2019-ncov/vaccines/different-vaccines/Pfizer-BioNTech.html)  The Moderna vaccine is reported to be similarly effective at 94%  (https://www.cdc.gov/coronavirus/2019-ncov/vaccines/different-vaccines/Moderna.html) 

These numbers are a little difficult to track from an independent source as breakthrough cases (infections without hospitalization or death following vaccination) are not reported to VAERS.

Are COVID vaccines safe?
At this time, COVID vaccines have received an emergency use authorization.  This means that the FDA makes a product available to the public based on the “best available evidence,” without waiting for all of the evidence necessary for formal FDA approval.  For formal FDA approval, adequate evidence must be necessary to determine that a product is safe and effective for its intended use and can be manufactured to meet quality standards.  (https://www.fda.gov/consumers/consumer-updates/understanding-regulatory-terminology-potential-preventions-and-treatments-covid-19)

Currently, the big side effects making the news are anaphylaxis (severe allergic reaction in 2-5 per million), thrombosis with thrombocytopenia syndrome (36 of 11 million with the J&J vaccine, highest risk in women under 50), myocarditis (511 cases reported, 323 confirmed mostly with mRNA vaccination, most common in young males), and death associated with vaccination (5,343).  Now, to clarify on the last number.  These deaths have been reported to VAERS as occurring after vaccination, although at this time there isn’t a way to discern whether the vaccination was the direct cause of death.  If a causal link was shown, it would constitute a rate of 0.0017%  (https://www.cdc.gov/coronavirus/2019-ncov/vaccines/safety/adverse-events.html)

Does natural immunity from COVID provide protection?
In Lombardi, Italy 1,579 patients were followed for an average of 280 days after COVID 19 infection, and of those, only 5 (0.31%) were reinfected.  Of those 5, only one was hospitalized.  (https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2780557)

Over 5 months, 1,359 caregivers at Cleveland Clinic who had previous COVID 19 infection and did not receive vaccination had no recurrent COVID infections detected.  (https://www.medrxiv.org/content/10.1101/2021.06.01.21258176v2.full)

What do the experts say?
Formal evaluation of the COVID vaccines in pregnant women with controlled studies have not yet been published, although some trials are in the works.  Because of this lack of information, the WHO suggests vaccination with mRNA vaccines only for pregnant women with either high risk of exposure, ie healthcare workers, or those with comorbidities that may increase risk of severe disease.  (https://www.who.int/news-room/feature-stories/detail/the-moderna-covid-19-mrna-1273-vaccine-what-you-need-to-know)

 ACOG suggests that all women, including pregnant and lactating women, have access to COVID 19 vaccination, as well as the most current safety information, and that they should be supported in whatever decision they make.  (https://www.acog.org/clinical/clinical-guidance/practice-advisory/articles/2020/12/covid-19-vaccination-considerations-for-obstetric-gynecologic-care)

In summary, there are still a lot of unknowns regarding COVID 19 infection, vaccination and particularly how each might affect pregnancy.  We don’t yet know how long immunity from vaccination or previous infection lasts, although it looks like both may provide initial protection against COVID 19 infection or reinfection, respectively.  We will continue to await information on efficacy of the vaccine and immunity against different COVID variants.  Even though we have some idea how COVID 19 may affect a pregnant woman during her pregnancy, we don’t yet know how either infection or vaccination may affect a developing fetus in the long term, and unfortunately, by the time we do, the babies most affected will no longer be babies, and the pregnant women most affected will no longer be pregnant.  At TWHC, we will continue to monitor what data is available and provide updates as we can.  In the meantime, our goal is to provide the relevant information for each mother-to-be so that she can make the best decision for her.

Dr. Nick

While gender transition medications/procedures aren’t services that our office offers, we still get questions from parents about the effects of these treatments on adolescents.  Based on these questions, we’ve looked into health implications for those who elect to undergo these treatments.  Here’s what we’ve found:
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Clinics that treat gender dysphoria have noticed some interesting trends in the number of adolescents identifying as trans in the last decade.  First, the number of adolescents identifying as trans has increased dramatically.  Second, gender clinics have seen a huge shift from primarily transfeminine patients (assigned male at birth) to a majority of transmasculine patients (assigned female at birth).  Historically, gender dysphoria presented in early childhood (ages 2 to 4) and was predominant in those born as boys.  Suddenly, we have seen a huge increase in individuals identifying as trans and instead of young boys with gender dysphoria, its adolescent girls with gender dysphoria.  So, what happened?  There are lots of possible explanations, from the influence of social media to the fact that it is more acceptable now adays to come out as trans.  The purpose of this blog is not to determine the reason behind this huge shift in demographics in the trans movement, but rather review the risks associated with medications for gender transitioning and surgery in adolescent natal girls.  What do these medications/surgeries do, are they permanent and what are the risks associated with taking them?

1. Puberty Blockers: When a girl enters puberty, her hypothalamus signals the pituitary which is a gland in the brain to send signals to the ovary to start producing hormones which will allow ovulation to occur (release of an egg from the ovary).  Puberty blockers usually a drug called Lupron, will shut down this entire process and prevent puberty from happening.  So, is this safe to do to a teenager who has not undergone puberty yet?  What are the risks?  First, these puberty blockers will stunt a teenage girl from growing in height and weight any further. She will likely be very short, as her longterm height will essentially be whatever height she is at time of beginning the medications.   It will also prevent breast formation, pubic hair/underarm hair and menstruation.  There is also concern that this will affect brain development and IQ as well.  Suppression of normal bone development also increases the risk of osteoporosis- her bones will be brittle, and she will more susceptible to fractures if she falls.  If a child moves from this to cross sex hormones like testosterone, the likelihood of becoming infertile is essentially guaranteed. 
2. Cross Sex Hormones: For teenage girls who have already been through puberty who are considering transitioning to male, the medication of choice is testosterone.  Testosterone does a lot of good things for mood, especially for someone who suffers from anxiety or depression.  It suppresses anxiety and lifts depression and produces a form of euphoria.  It makes you bold and unafraid.  It increases muscle mass and makes you stronger and increases your sex drive.  Testosterone redistributes fat away from the thighs and hips, and it causes body and facial hair to grow.  The girl will look like a boy.  It also causes severe vaginal atrophy (thinning, drying, inflammation of the vaginal walls that makes intercourse painful and can cause painful urinary symptoms as well).  After a few months on testosterone, the voice will crack just like an adolescent boy entering puberty), severe acne may follow, and even male pattern baldness.  It will cause the nose to become rounder and the jaw squarer.  Because testosterone thickens the blood, it increases the risk of having a heart attack by five times what a woman not on testosterone would have.  It also increases the risk of having a stroke, blood clots, and diabetes.  Testosterone also increases the risk of uterine cancer because of the effect it has on the lining of the uterus, and longterm use markedly increases the chances of permanent infertility.  Within several months after beginning testosterone, the changes to the body, like facial hair and voice changes, are all likely permanent.  These changes will persist even if she decides to transition back.    
3. “Top Surgery”:   For adolescents considering transitioning, the desire to proceed with bilateral mastectomy (removal of both breasts) is not uncommon.  One of the biggest misconceptions about this surgery, since breast augmentation is so common, is that if they change their mind, they can just get a “boob job”.  Unfortunately, this is not true.  Once the breast tissue is removed, if spacers are not placed at the time of removal (like we do for breast reconstruction following mastectomy for breast cancer), there is no way to do an augmentation that will look like real breasts again.  These individuals will also lose the ability to breastfeed it they ever decide to detransition or have a family.  Other risks include scar appearance, infection, seroma formation (where fluid accumulates and then drains), pain, bleeding, and distortion of the nipple. 

Hopefully, this blog helps to explain how gender transitioning medications and surgeries work as well as the risks involved for adolescent natal girls (born as a girl).  While we don’t feel that it’s our place to decide what’s best for your teen’s health, particularly regarding services that we don’t offer, we did want to provide patients and their parents (if the patients are minors) with information about the medical implications of these decisions.  Knowing about the potential side effects and being aware of the permanence of these therapies is important in making a well-informed decision that will affect their future. 
Dr. Pam