With over 70% of Americans taking at least one prescription medications and 20% of Americans on 5 medications, it's not surprising that patients are noticing changes in their health other than just what these medications are taken to improve.   Side effects can range from from as mild as an occasional headache to as severe as bleeding from the intestines.  In this blog, we'll take a look at some of the more common complaints from patients.

1.  Weight gain - many women come to my office concerned about their weight, and the go-to medication for blame is often the birth control pill.  Unfortunately for them, while we can see up to a 5% weight gain on Depo Provera injections, typical weight gain, if any, on the pill is between 1 and 4 lbs, and this weight usually goes away after several months of being on the birth control pill.  That being said, there are a number of other common medications that can be associated with weight gain.  Many of the most common antidepressants, especially SSRIs, have been associated with weight gain, in some cases as much as 24 lbs in a year.  Other mood stabilizers can also contribute to weight gain, as can steroids, antihistamines (sorry fellow allergy sufferers!), antiepileptics, and some blood pressure medications.

2.  Loss of libido - as I was reviewing the data for this article, it turns out that there are a LOT of medications that can affect libido, and many of them have negative effects.  We again see SSRIs as a very common culprit for loss of libido.  Birth control is also a common medication blamed for loss of libido, but as opposed to weight gain, in this case, certain types of birth control may decrease libido.  The goal for hormonal contraception is to prevent pregnancy, but some formulations can decrease testosterone, which in turn may reduce libido for some patients.  For others, this change may be a benefit these same decreases in testosterone can improve acne.  Other medications that may decrease libido are pretty similar to those may cause weight gain:  mood stabilizers, antiepileptics, some blood pressure medications and also opioids.

3.  Fatigue - pretty much any of the medications listed above may also cause tiredness or fatigue.  We can include some antibiotics and heartburn medications in this group as well.  If you've recently started any of the medications listed above and have noticed some loss of energy despite adequate sleep, exercise, and nutrition, then it may be worth examining the medicines you're taking.

4.  Insomnia - the counterpoint to fatigue, but if you're not able to sleep, then you're definitely going to be tired.  Some of the more common medications that may negatively affect your sleep include supplemental thyroid medications, ADHD medications, weight loss medicines, steroids, and once again, some of the antidepressants and mood stabilizers.

For some women, their prescriptions can cause nearly as many problematic symptoms as they improve.  While we often look for a simple fix for health issues, the side effects of any medications should also be taken into consideration, and the pros/cons of these medications should be discussed with your provider.  In some cases, there may be non-medicinal options to manage your health concerns, whether diet/exercise for weight/mood, meditation for sleep/focus and other non-prescription treatment options.  That being said, before making any changes with your prescribed medications, be sure to discuss any adjustments with your prescriber as they will be familiar enough with your health history to ensure the desired change is appropriate.  Together, you and your provider can ensure your medical regimen is optimal for your health goals :) 

Dr. Nick​

I get this question a lot from my patients during their postpartum visit.  “So, I just had a baby and would like for my kids to be close in age- when is the best time to have my next baby?”
In the medical literature, this is called “birth spacing” and there have been lots of studies that have looked at ideal timing between pregnancies. 

1. What is optimal time to wait between pregnancies?  If you are <35 and healthy, the ideal time to wait before planning your next pregnancy is 18-24 months and less than five years.  If you are over the age of 35, as fertility decreases at this age, the ideal interval may be closer to 12 months.  Remember these numbers do not apply to a miscarriage.  Most people with a first trimester loss are safe to start trying during the menstrual cycle following their loss.  However, you should consult with your doctor as they would be aware of your medical and pregnancy history and would be able to help you plan accordingly. 
2. What are the risks of spacing a pregnancy closer than the recommended intervals?  Studies have shown that pregnancy within 6 months of a live birth increases the risk of premature birth, placental abruption, low birth weight, anemia, and congenital disorders.  Very closely spaced pregnancies often do not give mom enough time to recover from pregnancy and breastfeeding, as this can deplete your folate and iron stores, and which is why they are at higher risk of being anemic. 
3. What are the risks of waiting too long? Long intervals between pregnancies can affect fertility and can increase the chance of developing preeclampsia.  Moms over the age of 35 have increased risks of preeclampsia, hypertension, diabetes, problems with the placenta and stillbirth.  There is also a higher chance of having a baby with a chromosomal issue.
4. What is different if I had a c-section?  If you have had a c-section, waiting at least 6 months is preferred in order to allow the uterus to heal and decrease the chance of uterine rupture.  Most physicians also require a minimum of 6-12 months between pregnancies if you are considering a vaginal birth after cesarean (VBAC). 

Planning your family can be tough.  Even if you have the perfect plan in mind, there’s no guarantee that your body will cooperate, but by keeping the above guidelines in mind, then you can help make your pregnancy safer and more likely to result in the outcome you (and your provider) are hoping for:  healthy mom and healthy baby 😊

Dr. Pam

For many moms-to-be, the focus is on getting pregnant, but once that happens, there isn’t always great information on what to expect during labor.  As the end of pregnancy looms, some expectant mothers don’t have a clear idea of exactly the next step is going to be.  So, here’s a quick overview looking at the end of pregnancy and delivery.

​When should I expect pregnancy to end?  Full term for pregnancy is beyond 37 weeks, and your due date is at 40 weeks.  We offer induction for patients who haven’t gone into labor spontaneously by their due date because we can begin to see an increase in the risk of stillbirth and need for cesarean section in pregnancies beyond a certain duration.  In fact, the ARRIVE trial suggests that we may even see a reduction in risk for cesarean section with inductions as early as 39 weeks.

How does this labor thing work? 
There are 3 main stages, and the first stage of labor has two parts.  Latent labor, or the beginning of contractions, can last anywhere from hours to weeks.  This process involves the cervical change from closed (0cm) to 4-6cm.  For some women, these contractions may not be noticeable until near the end of latent labor whereas for others, there can be significant discomfort and even frustration if the intensity of contractions increases without cervical change.  Active labor starts between 4-6cm and often progresses around 1cm per hour or sometimes even faster.

The second stage of labor begins following full dilation (10cm).  This stage involves pushing and delivery of the baby.  The second stage of labor can last anywhere from one contraction with pushing (usually a mom who’s done this before) to as many as 3 hours for first-time mothers in certain situations.

After baby gets here, the last stage of labor is delivery of the placenta.  This generally happens shortly after the delivery of the baby, although in some cases the delivering provider has to manually extract the placenta by placing his/her hand into the uterus to remove the placenta.

What conditions would cause the need for intervention for either my baby’s health or my health?  Sometimes, an intervention can be as simple as adding Pitocin to help labor progress.  Since prolonged labor can result in increased risk for intrauterine infection, abnormal heart rate for baby, low oxygen levels for baby and increased need for cesarean delivery, we like to see contractions reach a level of intensity that will continue to cause the cervix to dilate.  Sometimes, the pushing process can cause a lot of stress on the baby, and in this case, operative vaginal delivery (vacuum or forceps) may be indicated.  Also, while we prefer to allow the vaginal tissue to stretch to minimize tearing, an episiotomy (cutting the vaginal tissue) may be required to speed the delivery of a baby in distress.  A cesarean delivery is generally reserved for when all other options have either been tried or are not appropriate.  Some reasons for cesarean delivery can include a baby that is too big to pass through the bones in mom’s pelvis (i.e. mom has been pushing for a long time without having the baby move closer to delivery), a heart rate pattern for baby that suggests waiting for the entire labor and delivery process would increase risk of harm to the baby, or if mom’s cervix stops dilating despite having adequate contraction strength from the uterus.

What can I do to prepare for delivery?  I’d suggest making sure that you and your partner know how to get to the labor and delivery area of the hospital, especially after hours as some doors may be closed during the middle of the night.  If your significant other takes you on the “scenic route” to labor and delivery, you may not appreciate the detour.  I’d also suggest getting a bag together of the things you might want in the hospital for a several day stay.  If you’re not sure what to pack, you can check out a sample packing list here:  https://www.tetonobgyn.com/blog/what-to-pack-for-the-other-labor-day4298355  Lastly, knowing the reasons to go to the hospital are very important.  If you think you might be in labor (generally painful contractions every 5-7 minutes for an hour, although you can always go if you’re not sure), if you think your water has broken (even if you’re not in labor), if you’re concerned that your baby isn’t moving normally, or if you have heavy vaginal bleeding (more than a pad per hour), then you should go to labor and delivery.  You don’t have to call for permission in any of those cases as sometimes we can be busy in a delivery and not able to immediately return a call.  We don’t want you waiting on us to call back while you have your baby in the bathtub.  Just head to the hospital, let the nurses know what’s going on, and they will start an assessment while they get in touch with us.

While a list like the one above can’t take all of the uncertainty out of your labor and delivery course, it can provide a little more information about what can happen and what you might expect.  As every woman is unique, so, too, is her pregnancy.  Please be sure to discuss any concerns you have with your provider, and we hope that you have the perfect labor, delivery and new baby for you 😊

Dr. Nick