Teton Obgyn Idaho Falls
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Why Does My Mean OBGYN Make Me Wait Soooooo Long For That First Visit?!

6/27/2017

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For many women, they want to see their baby as soon as they miss their first period, either from excitement (can’t wait, can’t wait) to worry (is my baby ok, are you sure?!).  So, why does your doctor make you wait so, so long?​

Believe it or not, there’s a reason!  For your doctor to be able to definitively tell you about the health of your baby, it actually takes 45 days from your last period.  This doesn’t include an expected one week margin of error that your ultrasound may differ from the date suggested by your period (think of it as some kids are bigger or smaller than others, even at this early age).  Using an average measurement, we need to see a baby of 7mm in size to determine whether or not a pregnancy is successful.  Alternatively, if you come in before the part that becomes the baby develops, you may have to wait up to 2 weeks for that part to form!  That’s a long time to have to worry, and it adds to expenses for another ultrasound and/or labs.  That’s a lot of money you could save for diapers!

Not to mention, we still may not be able to give you a definitive answer before that time, no matter how much we’d like to.  There can be some findings that may make a pregnancy less likely to be successful (or even require earlier/emergent treatment in some cases), but we don’t want to give up on a pregnancy that may simply be slower to develop!  We understand waiting sucks, but that being said, by using the more conservative guidelines, we’re able to allow every possible chance for a successful pregnancy.

I’ve attached some charts below so you can see we aren’t fibbing or just mean!  Good luck, and we wish you all healthy, successful pregnancies!

Dr. Nick
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Moo-vers and shakers:  Could alternative milks affect children's height?

6/20/2017

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Over the last couple of decades, non-dairy milk products have become all the rage: Almond milk, soy milk, rice milk, cashew milk, coconut milk, and even hemp milk (is that a real thing?).  It used to be you only had to choose from skim, low fat or whole milk.  So how did all these non- dairy alternatives become so popular?  As consumers have become more concerned about “healthier” options, the nut-based milks are growing in popularity and have easily become a billion-dollar industry.​

Are these products really an alternative to dairy milk?  The American Journal of Clinical Nutrition recently published a study in June 2017 that showed children that consumed non-dairy milk were shorter than their peers who drank cow’s milk.  The study included over 5,000 children in Canada from 2 to 6 years of age and showed that a 3-year-old child that consumed 3 cups of non-dairy milk was 1.5cm shorter than a 3 year- old that consumed 3 cups of dairy milk daily.  The surprising thing here is that it is based on how much non-dairy the child is consuming.  The more cups of non-dairy milk the child consumes, the shorter they are.  One of the big questions is whether this correlates to adulthood- just because a 3 year old is 1.5cm shorter, will they be shorter as an adult?  Also, while there appears to be an association, this study doesn't necessarily prove that non-dairy causes the height discrepancy.  We don’t know- this study was only conducted in children and we don’t presently have data to support height differences in adulthood. 

What would explain this discrepancy in height?  Dairy milk products tend to have 8g of protein per cup, while most non-dairy milk products tend to have only about 1g of protein per cup (they all vary so you must look at each products’ nutritional label).  In addition, a lot of the non-dairy alternatives are sweetened or flavored and so they may have extra calories and sugar.  Also, many of the non-dairy options don’t naturally have calcium and vitamin D: They are fortified and if you do not shake the container, it will settle to the bottom.  It is very important when purchasing these alternatives, you carefully look at the nutritional information to ensure that it has protein, calcium and vitamin D, and is low in added sugar.

It is important that you scrutinize the nutrition labels on food for you and your children.  Just because a product is marketed as healthier, does not mean it has the appropriate nutritional content for your family.  For instance, many lower-fat alternatives may actually have more sugar and overall calories than their replacements.  Many times, there are so many additives that these options may end up being nutritionally poor for a growing child.   That being said, the very best resource for information about your child's health is your pediatrician.  Be sure to ask him/her if you have any nutritional questions for your growing child :)

Dr. Pam

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Since Your Baby Doesn’t Come with an Owner’s Manual Chapter 2:  The Second Trimester

6/13/2017

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For many women, the second trimester is often the favorite.  Nausea generally subsides (or at least lessens), moms can begin to feel their babies move, and the baby hasn’t yet become large enough to make you too uncomfortable :)  If you’re planning a “baby moons,” the second trimester is probably your best bet.​

The second trimester is often when you get to really see your newest family member for the first time.  While earlier ultrasounds can show some features, the ultrasound done around 20 weeks lets us look at all those little parts, from heart and lungs to fingers and toes.  And of course, if you haven’t learned already (or even if you have), this is usually the best time to confirm the gender of your baby.  At this point, if Pinterest and Etsy browsing for baby clothes hasn’t already become your favorite pastime, it probably will :)

From the OBGYN standpoint, with the exception of the 20 week ultrasound to assess your baby’s anatomy, our testing is generally pretty limited.  Visits continue every 4 weeks during the period, and each visit will include listening to your baby’s heartbeat.  After 20 weeks, we will begin to measure the fundal height (measurement from the pubic bone to the top of the uterus) in order to ensure your baby is growing well.

The only downside of the second trimester is that we do perform one of the 2 least favorite tests of pregnancy:  the screening for gestational diabetes.  It’s kind of a tossup as to whether this test or the check for group B strep in the third trimester is the least favorite of moms-to-be.  Since this test isn’t so fun, I’d like to take a minute to explain what it is and why we do it.

The way we do screening for gestational diabetes is as follows:  you get to drink a sugary drink provided by the lab and then have your blood drawn an hour after.  If you pass, you’re done, and if you fail above a certain level, we begin management for gestational diabetes right away.  If you fall in the middle, we do a second round of testing (a 3 hour version) to determine if you have gestational diabetes.  We know all moms have some element of insulin resistance during pregnancy (we want your blood sugar to be a little higher than your baby’s so that he/she can eat); however, some moms are over-achievers :)  For those moms, dietary modifications and in some cases medical management may be indicated.  Glucose control is one of the most important aspects of pregnancy as uncontrolled gestational diabetes can lead to larger babies, increased risk of birth trauma to baby/mom or need for cesarean section, and in severe cases, even increased risk of stillbirth.  So, yes, it’s not a fun test, but it is important.

The last important milestone for the second trimester is that around 23-24 weeks is the very earliest that babies have a chance to survive outside of mom’s body.  That being said, we much prefer that your little one gets to stay inside awhile longer.  Complications from prematurity can generally be minimized the further pregnancy progresses, so even if you’re finding that the second trimester isn’t a total breeze, remember that after 20 weeks, you’re over halfway to getting to see your baby in person and that cute little face will be totally worth it :) 

Dr. Nick
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I Think I want a Home Birth????

6/6/2017

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Sometimes patients tell me, I would really like to labor in the comfort of my own home.  I don’t want to be attached to fetal monitors, IV’s, medications or anything.  I would like to be in my own tub laboring in peace.  I also don’t want any pain medication, so do I really need to come to the hospital?  Ultimately, it’s up to you and the complexity of your pregnancy.  While it’s not a service we offer, here are a few considerations for those who are considering this option.
The most common arguments for home births that I hear are…Women have been doing it for thousands of years so why do I need to be in a hospital.  So it’s generally not about the mom, it’s more frequently about the baby.  Of the studies that have been done comparing home births versus hospital birth, there is no increase in maternal mortality, but there is a significant increase in infant mortality.  That being said, the number one cause of maternal death in developing countries is postpartum hemorrhage, and access to postpartum pitocin has been the most critical medication for reduced risk of postpartum hemorrhage.  As for babies, the risk of neonatal (infant) death is actually elevated at 2 to 3 times higher with home birth than in the hospital.  This is rather concerning as it does not take into account that most women that elect home birth are healthy with low risk pregnancies. Hospital births include everyone: high risk pregnancies, women with lots of medical problems who sometimes are very sick even before they become pregnant, and women with no prenatal care.  So, despite the fact that most home births involve very low risk pregnancies, the fact that infant death is so much higher is somewhat worrisome.  If you do decide to go with a home birth, please make sure that your home birth attendant is certified in infant resuscitation and has plenty of experience.  The number of births attended may vary markedly from one midwife to the next, so be sure to take her experience into consideration.  It may also be prudent to select one that feels very comfortable taking care of the baby in case a complication arises.

What is the chance that I will be emergently transported to the hospital from home?  The chance is actually probably higher than you might think if you are a first-time mom: about 30%.   Reasons can include fetal distress or very slowly progressing labor.   If you are not a first-time mom, that risk is around 10%.  Being transported emergently to the hospital without an established provider can be a pretty harrowing experience, and it’s important to be aware that home birth attendants often don’t have privileges to manage your care once you reach the hospital.  That being said, a provider’s transport rate can be a little misleading as well.  Often, a home delivery attendant with a higher transport rate tends to have slightly better outcomes as she may be avoiding worse outcomes by allowing more timely intervention for complicated patients.  Please know where your closest hospital with good maternal and infant care is located, just in case.

I guess the final question if you elect a home birth is who will clean the floors and the tub ;)   Whatever you decide, we want you and your baby to be safe and healthy, so as you hope for the best, be sure to plan for the “just in case”  :)

Dr. Pam
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