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Are All Birth Control Pills the Same?

1/31/2017

The birth control pill has been on the market for more than 50 years.  It has really allowed women to take control of their lives and decide when they are ready to start a family.  It also helps many women control their symptoms of heavy bleeding and pain during their cycles.  However, there are literally hundreds of different types of birth control pills out there.  So how do I know which pill will work best for me?  First, let's talk about the different types of pills: There are combination pills and the mini-pill.

1.       Lets start with combination pills They contain two types of hormones: estrogen and progestin.   They prevent pregnancy by preventing ovulation, thickening cervical mucous and thinning the lining of your uterus, thus preventing a pregnancy from implanting there. The patch and the nuvaring have both hormones and so are essentially comparable to the pill. Different types of combination pills have different types of estrogens and progestins and at different dosages.

2.       Let's further break it down: There are two major types of combination pills: monophasic pills and triphasic pills.  Monophasic pills have the same amount of estrogen and progestin in their active pills. Triphasic pills vary the amount of hormones every week.  The marketing guys for triphasic pills claim that they are trying to mimic the hormonal changes that happen during the cycle.  However, there is no evidence that says that triphasic pills work better or have any other benefit.

3. Different combination pills have different amounts of estrogen. Is a low dose estrogen pill better for me since it has less hormone?  Not necessarily.  Some women are very sensitive to the effects of estrogen, and higher doses can cause worsening nausea or breast tenderness.  For them, a low dose estrogen pill may help with these symptoms.  However, low dose estrogen pills are notorious for causing breakthrough bleeding.  So while your breasts may be less sore, you may be bleeding a lot more.  I guess it's pick your poison, huh?

4.       Different combination pills have different types of progestins.  Some progestins may be less androgenic than others.  What does that mean? Essentially some progestins may help decrease acne or affect unwanted hair growth.

5.       What if I can't take a combination pill?  For some women, the combination pill can worsen preexisting health problems. If you are over the age of 35 and a smoker or have high blood pressure, diabetes, history of blood clot or have migraines with aura, you may not be a candidate for combination birth control that includes estrogen and progestin.

6.       So what is the mini-pill?  The mini-pill only contains progestin.  It thickens cervical mucous and thins the lining of your uterus, but does not necessarily prevent ovulation.  The mini-pill is usually a great option for women who are not allowed to use the combination pill because of certain medical conditions or if they are breastfeeding.  The estrogen in the combination pill can decrease milk supply and so for breastfeeding women, the mini-pill is recommended.  With the mini-pill, you must take it at the same time every day to prevent pregnancy.

So back to which pill is best for me.  It's not that easy, is it?  It is best to have a discussion with your provider.  Based on your medical history and goals of treatment, together, you can come up with a plan to best suit your needs. Keep following for a follow-up blog: Does the birth control pill make me fat and crazy?!

Dr Pam

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Finally, a way to predict gender before conception?!

1/24/2017

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On pretty much any given day, I’m asked how to anticipate gender based on various factors from how a baby is carried to the rate of the baby’s heartbeat. Previously, there hasn’t really been any good answer, unless the pregnancy occurred via in vitro fertilization. We’ve know for a long time that there is a slight overall predisposition to the delivery of a male baby, which is present as long as the general population is healthy and unstressed; however, when the population undergoes significant stress, whether manmade or natural in origin (economic depression, terrorist attack, tsunami, etc.), there is an increase in the number of girl babies delivered. This is thought to correlate to increased spontaneous loss of “weaker” male fetuses. We’ll let you debate with your partner over whether that still applies ;) To an extent, though, it’s true, girl babies are generally tougher and do better with overcoming adverse pregnancy and delivery conditions. Personally, I’m not surprised because I’m pretty sure a Braxton-Hicks contraction would be the end of me!

Now let’s get down to the good stuff! Even though the sperm (thanks dad!) determines gender of the fetus, the researchers for this study wanted to figure out how the environmental factors above could affect the chance of moms giving birth to a boy or girl. That’s a fancy way of saying what makes some moms more likely to have boy or girl babies when they don’t have control over the baby’s gender. After examining about 1,500 women from 6 months before conceiving until delivery, it turns out that mom’s blood pressure is the only significant difference between mothers who had girl babies and boy babies. This study evaluated everything from BMI to medical history to cholesterol, but blood pressure at 6 months before conceiving (not during pregnancy), was the only measurable difference between moms for baby boys and baby girls. Essentially, the higher the blood pressure at 6 months before delivery, the more likely it was that mom would deliver a boy.

So you’re saying if I gain some weight and have my husband really make me mad (or more mad than usual), then I’ll have a boy, or if I diet and exercise to bring down my blood pressure, I’ll have a girl?! Unfortunately, it’s not that simple. This is the first study to show any link between mom’s blood pressure and baby’s gender, and it didn’t prove that the blood pressure caused the baby to be a boy or girl. While something like that may be possible in the future, changing your blood pressure hasn’t been shown to change the gender of your future baby, and there are other health concerns to think about when blood pressure changes. Still, it is exciting to know that scientist are learning more about the process that determines what moms deliver boys and what moms deliver girls, and for now, I’m sure you love your fifth little slugger just as much as you would your first little princess :)

Dr Nick

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Why is my baby bump bigger than hers (she’s 28 weeks, and I’m only 20 weeks!)?

1/17/2017

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All mothers to be like to compare baby bumps. It’s not fair that I’m not as far along as you, but my bump is way bigger.

1.       Baby bumps come in all shapes and sizes. The most common reason to have a baby bump that sticks more outward than upward is dependent on which number pregnancy it is. First babies tend to grow upward towards your diaphragm, and subsequent babies tend to grow outward like a basketball. The reason for this is because as you have more children, your abdominal muscles tend to become more lax, so your bump is more likely to grow outward.

2.       Does a bigger bump mean a bigger baby? Not necessarily. Just because your bump is growing outward instead of upward does not necessarily mean your baby is bigger. A more accurate way to determine the size your baby is by measuring your fundal height. Your doctor will start measuring your fundal height after 20 weeks. The fundal height is the distance from your pubic symphysis to the top of your uterus (aka the fundus). This measurement is done in centimeters. Most providers will measure the fundal height after 20 weeks because at 20 weeks the uterus will be at the belly button. Before that it can be difficult to measure accurately. Ultrasound is generally used at or before 20 weeks to assess the size of the baby.

3.       Does my height affect the size of my baby bump? It may. Women with a short torso are more likely to have “a bigger bump” than someone who is taller, but this does not tell us anything about the baby size. It just tells us that the baby has less room to grow upward, and so it is more likely to grow outward. Babies of shorter women tend to actually be smaller just because more petite women tend to make smaller babies.

4.       When can I finally see a baby bump? Most first time mothers will not notice a bump until the second trimester- sometime around 14 to 16 weeks, although if this is not your first baby, you may notice a bump sooner. Some women may confuse bloating in the first trimester with a bump.

5.       Is it true that if my bump looks like a basketball I am likely having a boy and if it looks like a watermelon I must be having a girl? Unfortunately, this is just an old wives’ tale. Gender has nothing to do with the shape of your baby bump. The shape of your bump is more likely related to which pregnancy this is, the size of your torso, and the strength of your abdominal wall.

6. Does a bigger bump mean I am going to get a hernia? A hernia is where the intestines can protrude through a weakened portion of the abdominal wall. Most pregnant women will experience some separation of the rectus muscles (diastasis recti), but most pregnant women do not develop a hernia simply because they are pregnant. However, if you have a preexisting hernia, pregnancy can make the hernia worse.

There you have it! Baby bumps can be big or small, grow out or up, and even vary from one pregnancy to the next. Regardless of how your bump grows, we’re here to help you deliver the healthiest possible baby from your bump :)

Dr. Pam

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Everything you always wanted to know about pregnancy but were too embarrassed to ask part 2: Sex and the Baby

1/10/2017

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Everyone knows (hopefully) that sex is critical in making a baby, but I often get questions about how sexual function is affected by pregnancy. So, here it is: a user-friendly guide on being intimate during pregnancy.

Can sex hurt the baby? Generally speaking, there aren’t many contraindications to sex during pregnancy. If there is bleeding in early pregnancy, your obstetrician may recommend a period of pelvic rest (no placing anything into the vagina), or if your placenta is located too closely to the cervix, then you may have to defer sexual activity due to risk of bleeding. Otherwise, unless your water has broken or your cervix is significantly dilated, then you should be good to go (but only if you want to!). As far as trauma to the baby, intercourse isn’t expected to “shake” the baby or poke him/her in the eye ;)

Good thing it’s ok to have sex, because I’m super-frisky! Some women have expressed concern about increased libido while pregnant. Even with nausea, increased acne, GI issues, or limited comfortable sexual positions, there can still be a significant increase in sex drive. The hormonal changes in pregnancy, particularly in the first trimester, and also the increased sensitivity of the breasts and vulvar tissue can be factors. Essentially, just ask your significant other if he remembers what it was like in junior high when he was going through puberty. These hormonal changes can be even more exaggerated if you have been on estrogen-containing contraception in the past, as certain types of birth control can affect sex drive. Lastly, there isn’t any stress associated with the effort to avoid (or achieve) pregnancy, and sex free of worry is certainly more fun!

Are there some positions that are preferable to others? As pregnancy progresses, you may find that some positions become uncomfortable to you, so definitely avoid these. Also, be sure to stay away from any position that places significant pressure on your abdomen as this can affect blood flow to the baby.

Uh oh, now I’m spotting and having contractions! Am I in labor?! One of the most common times patients come in for evaluation and labor checks is after having sex. Contractions are usually caused by a combination of the stimulation of the cervix and the prostaglandins found in semen (prostaglandins are one of the same compounds used in higher doses to induce labor). Spotting may occur due to the increased blood flow and sensitivity of the cervix. Many patients experience contractions that are mild or vaginal spotting after intercourse. These symptoms are quite common, and in most cases, we wouldn’t expect the contractions or spotting after intercourse to have adverse effects on pregnancy. However, if your contractions become painful and remain persistent for more than an hour, or if your spotting becomes heavy bleeding so that you soak through more than a pad an hour, then be sure to go into the hospital for evaluation. Also, if your blood type is Rh negative and you have any vaginal bleeding at all, be sure to notify your provider.

Many women experience a normal (and healthy) increase in both sexual drive and sexual satisfaction during pregnancy, and as long as there aren’t any medical contraindications, sex in pregnancy can still be both safe and fun. However, not all women have have these changes, and this can be normal, too. So, whether you elect to be intimate or not is ultimately up to you, and both choices can be part of a happy, healthy pregnancy :)

Dr Nick

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A Few Tips to Increase Your Breast Milk Supply

1/3/2017

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First of all, the most important step is to figure out if your breast milk supply really low. Remember if your baby is gaining weight properly and producing enough wet diapers, your milk supply is probably just fine. However, if your baby is fussy after feedings or drinks an entire bottle after nursing there may be a problem. Here are some tips on what you can to do to increase your supply.

1. Nurse nurse nurse: Your breasts will try to meet the demand of your baby. Nursing more frequently will help augment your production. Supplementing with formula especially during a growth spurt will negatively impact your breasts ability to meet the demand of your baby. That being said, sometimes you still may have to supplement in order to meet your baby’s needs.

2. When you are done nursing, pump, pump, pump. If you are going back to work, this is not easy! It essentially means you are either nursing or pumping every couple of hours. However, pumping regularly will allow you to produce plenty of milk for storage when you go back to work.

3. Hydrate!! About 2/3 of Americans are chronically dehydrated. You do not need to overdo it. Just make sure you are drinking fluids and staying hydrated throughout the day! If you are properly hydrated, your urine will have a clear, light yellow appearance. If it’s dark and yellow, then drink more!
4. Herbal options
A. Fenugreek: Fenugreek is an herb similar to clover and the herb most commonly recommended to help increase breast milk supply. Fenugreek is used as an herbal remedy to help with diabetes, painful menstrual cycles, exercise performance, male infertility, breastfeeding and many more indications as well. Studies have not shown a significant impact on breast milk production. However, anecdotally many mothers find that fenugreek (whether in capsules, seeds or tincture) can help increase supply. Side effect include sweat and urine smelling like maple syrup. Fenugreek is most commonly discontinued for causing loose stools. The amount of fenugreek transferred to breast milk is unknown. If your baby develops fussiness or loose stools, you may want to discontinue it and speak with your pediatrician. Please do not use fenugreek when pregnant as it can be a uterine stimulant.
B. Milk thistle: Milk thistle is a tall flowering plant from the Mediterranean. It is a common ingredient found in lactation teas and supplements to help increase breast milk supply. This herb is also commonly used in patients with liver disease or gallbladder issues. While there are no good studies showing increased breast milk production, it has been linked to breastfeeding historically.

5. Oatmeal? While there are also no good studies that show that oatmeal directly impacts breast milk production, many lactation consultants will encourage moms to eat oatmeal for breakfast. Its a good source of iron and nutrition, so why not?

6. Prescription medications
A. Reglan: Reglan increases milk supply work by blocking dopamine, which results in an increase in prolactin levels. This does not work for all women, and unfortunately reglan has lots of side effects. The most common is severe depression; other side effects include diarrhea, sedation, gastric upset, nausea, seizures and extrapyramidal effects (twitching, etc.). Even though it may be helpful in increasing production, because of all the side effects, especially in women susceptible to postpartum depression, it is generally prescribed very cautiously by providers.
B. Domperidone: This medication is associated with increased production and fewer side effects than reglan. However, it is available in Canada and not in the US as it has not been approved by the FDA. The FDA actually issued a statement against its use in 2004 as there was concern about its transfer into breast milk.

7. Lactation consultants! There are lactation consultants online (la leche leaugue), or you can meet with one of the lactation consultants at the hospital. If you call the hospital where you delivered, they should be able to help you make an appointment with one their consultants, even after you have been discharged from the hospital. Sometimes something as simple as poor latch can contribute to supply issues.

For those moms who are working hard to breastfeeding and are struggling with their supply, hopefully the tips listed above will help get you over the hump. If not, remember that breastfeeding isn’t always possible for everyone. While there certainly are some health benefits for baby, even if it doesn’t work out for you, that doesn’t make you a bad mother. Many healthy babies have been raised on formula, too :)

Dr Pam

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Are All Birth Control Pills the Same?

Finally, a way to predict gender before conception?!

Why is my baby bump bigger than hers (she’s 28 weeks, and I’m only 20 weeks!)?

Everything you always wanted to know about pregnancy but were too embarrassed to ask part 2: Sex and the Baby

A Few Tips to Increase Your Breast Milk Supply

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