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Since Your Baby Doesn’t Come with an Owner’s Manual Chapter 1:  The First Trimester

5/30/2017

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After delivering babies for the last 9 years, I have yet to see the birth of a baby with an owner’s manual, and no matter how prepared new parents try to be, pregnancy and a new baby are undoubtedly a life-changing experience.  What I’d like to do over my next few blogs is cover the time leading up to and just after delivery.  So here it goes, what to expect from you physician’s perspective.

When do I need to start preparing?  The best pregnancy planning begins even before conception.  Prenatal vitamins are generally advised for several months before attempting to conceive to ensure adequate levels of folic acid during the critical time to prevent neural tube defects (essentially spinal problems) in the developing embryo.  As an added bonus, some studies suggest a decrease in the severity of morning sickness for those who have been taking prenatal vitamins for several months before conception.  Win for baby and win for mommy!

More importantly, how soon can I see my baby?  Unfortunately, despite our expectation of instant gratification, our technology hasn’t quite caught up to the demands of anxious mothers-to-be.  While we may be able to see a gestational sac (the sac the baby grows in) as early as 5-6 weeks, we generally aren’t able to see the 3 parts of a successful pregnancy until around 7 weeks.  We want to confirm: 1. Pregnancy inside the uterus, 2. The part that becomes the baby is present inside the sac, and 3. There is a heartbeat.  While we occasionally see moms before 7 weeks, they may leave even more worried than when they came because we can’t always guarantee that the pregnancy appears healthy.  Not to mention, who wants an extra vaginal ultrasound :( It takes until 7+ weeks for the baby to be even a centimeter long, and even though it’s the cutest 1cm you’ll ever see, we want to be able to reassure you that it’s also the healthiest!   Besides, as a doctor, the last thing we want to cause is more stress to expectant mothers.  That’s the baby’s job for after delivery -- “Liam, are you seriously trying to eat my shirt?!” :P

So, what else happens at that first visit?  Your doctor will likely check labs, probably chat with you about pregnancy expectations, possibly discuss genetic testing and may do an exam.  Your provider may also inquire about any medical conditions or previous surgeries that would affect your pregnancy.  He/she will also answer any questions you may have and discuss any symptoms you may be having to determine if those issues are pregnancy-related or require further evaluation/treatment.  Most importantly, it gives you the opportunity to meet the person who will be helping to bring your bundle of joy into the world!

Speaking of symptoms, which ones are common during pregnancy?  The number one complaint in the first trimester is nausea.  Generally, it’s worst during the second half of the first trimester and begins to subside as the HCG (pregnancy hormone) begins to go down towards the end of the first trimester.  Since no one likes to spend all day hugging the toilet, we do encourage notifying your doctor if you aren’t able to keep any food down, even if it’s before 7 weeks.  The one silver lining to all of that nausea is that women with hyperemesis gravidarum (not nearly as cool as the name sounds!) tend to have a slightly less chance of miscarriage.  Other common symptoms include breast tenderness or enlargement, change in skin pigmentation, increased urination, food aversions and of course, missed menses.  Light vaginal spotting or bleeding with pregnancy implantation can also be normal.  That being said, be sure to notify your doctor for abdominal pain that doesn’t go away with Tylenol, heavy vaginal bleeding (more than a pad per hour) and passing large clots or tissue.  These could be signs of either a failing pregnancy or even a pregnancy outside the uterus, which is potentially a life-threatening emergency.  
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There you have it!  A quick look at the first trimester.  We’ll hit the high notes for second and third trimester in future blogs!  For all of those who are pregnant, congratulations, and for those seeking pregnancy, good luck!  Please give us a call at 208-523-2060 if you’d like our help in achieving a healthy, happy pregnancy for you and your baby!

Dr. Nick

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I Thought My Baby Wasn’t Supposed to Keep Me Up All Night Until After He/She Got Here!

5/23/2017

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​1. Why is sleeping so hard in the third trimester?
  • The average pregnant woman in the third trimester probably wakes up at least five times a night.   What contributes to this disordered sleep?  The most common reasons are back pain as the pregnant belly grows, frequent urination (the urge to urinate increases as the baby’s head puts pressure on the bladder), disordered breathing from vascular congestion in the nasal passages (even women who never snore prior to pregnancy notice changes in the third trimester), and restless leg syndrome
2. What can I do to get some sleep?
  • First, sleeping on your side (preferably the left) with your knees bent and with pillows between your legs and propped under your belly can help relieve some pressure off your back and help maximize circulation to the uterus.  Some women will use a body pillow which is essentially similar to strategically placed pillows.  Stretching, exercise, and prenatal massage can also help alleviate back discomfort.
  • Second, we want you to be well hydrated, but cutting back on fluids 2 hours prior to bedtime can help relieve urinary symptoms in the middle of the night.
  • Third, eating leafy green vegetables (foods high in folate and iron) can help with restless leg syndrome.  Medications that are normally prescribed for restless leg syndrome do not have a well-studied safety profile in pregnancy and so, most providers are hesitant to prescribe them to their pregnant patients.
  • If snoring is severe, it may be necessary to be evaluated with a sleep study to determine if a CPAP machine is necessary to ensure your airway stays open.
  • Turning down the thermostat may help as well.  As most pregnant women know, their body heat increases and they feel hot and sweaty all the time.  Decreasing the dial a couple notches on the thermostat can really help ensure that you get the sleep you need.
  • You may also want to make sure it's not reflux.  As your baby grows, your uterus places pressure on your diaphragm and this can force stomach acid into your esophagus, causing severe acid reflux.   There are many medications for reflux which are safe in pregnancy, but be sure to talk to your provider about these symptoms.
  • And finally, don’t forget about the importance of sleep hygiene. Try to unplug prior to bedtime: too much screen time with tv’s, tablets, phones and other electronic devices can really affect your ability to sleep.
3. What medications can I use to help me sleep if nothing else works?  Benadryl and Unisom are probably the most frequently recommended sleep aids that are over the counter and well-studied in pregnant women.  I would still discuss this with your provider before taking any medication for sleep.
 
Hope this helps you catch some zzz's!
 
Dr. Pam
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Vaginal Kung Fu:  Apparently, It’s a Thing

5/16/2017

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After being in obstetrics and gynecology for nearly 10 years, it’s rare that I get a question that leaves my jaw on the floor, but when a patient asked me about vaginal kung fu, she got me.  Once I gathered my composure, I offered to do some research, and here’s what I found.


Apparently, there are classes, and the pictures touting this routine display strings apparently anchored around a jade egg in the woman’s vagina (fortunately, we can’t really see through their clothes) and supporting everything from surf boards to coconuts.  By using ancient Taoist courtesan regimens, this routine alleges improved orgasms and increased libido by treating vaginal “numbness.” Other reported benefits include everything from easier childbirth, resolution of incontinence, ability to launch pingpong balls (not going there) and even improved skin tone allowing discontinuation of botox.  That is some serious clinching!

Given all of those purported benefits, who wouldn’t want to do it?!  The problem is that there isn’t really any science behind any of those assertions, but there may potentially be some risk of harm.  Here are a few of the concerns from urogynecologists (essentially the experts on pelvic floor musculature):

1.  There’s no certainty that the regimen works the intended target muscles, and even if it does, there’s no guarantee that this routine may not strain or even injure those muscles, which in turn may result in development of pelvic pain.  Lastly, even if it is safe and does target the appropriate muscles, there’s nothing to suggest that using suspended weights would provide any more effective treatment than simply doing kegels.

2.  Secondly, jade is porous, meaning that it has a bunch of tiny holes in it.  Tiny to us isn’t necessarily tiny to bacteria.  Even if you have an autoclave (fancy medical cleaning machine) at home, it seems like it would be really hard to keep the anchoring rocks free from bacteria.

3.  Third, this routine is based on holding, no actually clenching, rocks in the vagina.  As a guy, I wouldn’t want rocks rubbing against my complimentary man parts, so I can’t imagine rocks rubbing in a women’s vagina would be comfortable.

From an ob/gyn perspective, vaginal Kung Fu doesn’t exactly seem like a great idea.  Besides, even if spraining a muscle in the pelvic floor or exposing your vagina to rough, bacteria-laden rocks isn’t necessarily a deal breaker, I’d like to take a moment to be practical.  While you might be able to do kegels at work without anyone noticing, I’d love to see you explain to your child or significant other exactly why there is a fruit basket tied to a string where?!  If Little Johnny walks in on your exercise routine, he will need some therapy for sure!

In all seriousness, there are actually proven and safe ways to strengthen the pelvic floor.  It probably makes the most sense to start with kegels.  Here’s a link from the Mayo Clinic  http://www.mayoclinic.org/healthy-lifestyle/womens-health/in-depth/kegel-exercises/art-20045283  If that doesn’t work, take a moment to discuss your issues with your ob/gyn to help determine your next step.

Dr. Nick
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I Want to Have a Baby, but I can’t figure out when I am Ovulating!

5/9/2017

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What is ovulation and why is it important?  Let’s go over this conception issue: Egg meets sperm- simple enough, right?  Not exactly.  The sperm has to meet the egg at the right time.  The average menstrual cycle is 28 days and the first day of your period is considered day 1.  Your body has to prepare the uterus and the egg before the egg can be released (this is ovulation).  This takes about two weeks.  So about 14 days after your period starts is when the egg is released (aka ovulation occurs).  The egg is making its way down the fallopian tube to the uterus and if it meets the sperm along the way, then fertilization occurs.  Once the fertilized egg reaches the uterus, this is when implantation of the pregnancy can occur.  If implantation does not occur, then your period will start and the cycle will repeat itself.  The tricky part here is that the sperm has to be waiting and ready to meet the egg after ovulation happens.  Remember, it takes the sperm a while to get there too.  The best time to have intercourse is really the day before or the day of ovulation.  If you have intercourse the day after ovulation has occurred, this will likely be too late (the egg only lives about 12-24 hours).

How do I know when ovulation occurs?  Some people may have some pelvic pain at the time of ovulation.  However, most of us don’t get any special signals as to the time or day that it is occurring.  It is a bit of a guessing game.

What is the best way to approximate ovulation?  The best way to do this is to use an app (this is the cheapest way as well).  There are so many apps online that you can use:  Fertility Friend, Glow, Kindara, Clue, Period Tracker, and Ovia, just to name a few.  Many of these are free.  Just download it and input the first day of your last menstrual period and it will give you a fertility window.  The window is trying to capture the day before and the day of ovulation but it gives you a couple days before and a couple days after.  

Remember to have sex every day during your fertility window.  Many places will encourage you to have sex every other day to save up the sperm- don’t do this.  There is no truth to this- just have sex every day during your fertility window and if you happen to have sex the day of or the day before ovulation your chance of becoming pregnant can be as high as 30%.

A more expensive way to predict this is an over the counter ovulation kit.  What is this test for?  This test works by detecting a rise in Luteinizing Hormone (LH) in your urine, which usually occurs 24 to 36 hours prior to ovulation.  Several reasons my patients don’t tend to like this: Many people never get a rise in LH even if they are ovulating and it is also an added expense.

What not to do: Don’t check your basal body temperature!!!  Many places online will have you measure your temperature and record it.  This is useless, because your temperature does not go up until after ovulation has occurred and now you have missed your fertility window.

Am I ovulating?  If you have a period every month, you are probably ovulating.  If you have very irregular periods (such as every 3 to 4 months), you are not likely ovulating.  If this is the case, you should talk to your provider right away.  I hope this helps you determine when you are ovulating and taking that first step towards creating your family.  Still have questions?  Give us a call at 208-523-2060 and make an appointment to discuss your fertility issues.  Good luck, and happy conceiving :)

Dr. Pam
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Can You Wake and Bake with One in the Oven?  The Misperception of Safety of Marijuana Use in Pregnancy

5/2/2017

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Now that marijuana has been legalized, we’ve encountered an increasing number of patients who choose to use marijuana during pregnancy (up to 5% in most places, although as high as 25-30% in others).  Generally, use in pregnancy is based on the misconception that since marijuana is legal and “natural,” then it shouldn’t hurt my baby.  Unfortunately, this doesn’t seem to be the case, and here’s what the we’ve learned:

Natural doesn’t always mean safe.  Obviously, some mushrooms can be poisonous, and tobacco has a number of carcinogens, but even commonly consumed plants can make a person quite ill.  Rhubard stems are often used in pies, but eating their leaves can cause internal bleeding, coma and even death.  Castor oil, commonly taken when, you know, you gotta go, but you can’t go, is made from beans that contain ricin.  A single bean with the ricin still in it can be fatal to an adult in minutes.  Marijuana contains many of the same carcinogens as tobacco smoke but often in concentrations several times higher than tobacco.​

So, how does this stuff affect my baby?  We know that THC crosses the placenta and can be found in fetal circulation at 10% of the maternal level.  We also know that cannaboids, the part of marijuana that acts on the brain, can bind to fetal cannaboid receptors as early as 14 weeks of pregnancy (the beginning of the second trimester).  The number of cannaboid receptors in the baby increase throughout pregnancy.  Laboratory studies show that cannaboid exposure can disrupt normal brain development and function, and they can also sensitize the fetal brain to harm from alcohol exposure in women who use both substances.  Children exposed to marijuana while their mother was pregnant generally score more poorly on visual tests and motor coordination testing.  Additionally, exposure to marijuana in utero increases the risk of behavioral problems and decreased attention span as well as marijuana use in the child by age 14 (Sorry Mom, I was going to do my homework, but then I got high..).  Lastly, marijuana use in pregnancy may result in a baby with low birth weight.

The bottom line is that marijuana use in pregnancy and breastfeeding (it is secreted in breast milk) doesn’t seem to be a good idea.  So, if you are pregnant or thinking of becoming pregnant, then it’s probably a good idea to avoid marijuana.  Be sure to address any non-medicinal and medicinal drug use with your doctor to help you achieve your healthiest possible pregnancy :)

Dr. Nick
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