​I get this question all the time:  'My due date is here- is there anything I can do to help get this process started?'  Let’s take a quick look at some of the popular ways of trying to serve that eviction notice…

1. Exercise: Being active and getting the heart rate up is a great way to get your body ready for labor.  Even something as simple as going on walks can help bring that baby into the pelvis and place some pressure on your cervix making it more favorable for the labor process.  While there is no good evidence supporting this option, it may help you prepare for labor itself which is a physically intense ordeal. 
2. Intercourse: Sex can help through multiple different mechanisms.  First, semen contains prostaglandins which can help dilate and thin out the cervix.  Second, sex can help release a hormone called oxytocin which can cause contractions.
3. Evening Primrose Oil: This oil comes from the evening primrose plant and contains linolenic acid which is thought to trigger a prostaglandin response in the body.  This can be taken orally or placed vaginally.  However, while it is easily accessible, there are very few studies to show any benefit on the cervical ripening process.  One study even found that women who took the supplement were in labor for longer that those who had not taken it.  While it likely has no effect on breastfeeding, it can act as a blood thinner (possibly predisposing to heavier bleeding with delivery) and can have side effects like headaches and GI distress.  I would probably stay away from this one until more research is done. 
4. Red Raspberry Leaf Tea: The mechanism of action here is not clear.  However, some feel this tea “helps tone up the muscles of the uterus thereby preparing it for labor”.  However, there are no studies showing that red raspberry leaf tea can induce labor.  Since there aren’t any significant side effects, I guess if nothing else it can help you relax.
5. Castor Oil: Castor Oil is a laxative and stimulates your bowels by causing spasms.  The idea is this intestinal irritation can cause uterine contractions.  However, if you are not already in labor, this is likely only going to give you diarrhea and lots of GI distress.   I would definitely skip this one unless you want to be sick to your stomach. 
6. Nipple Stimulation: Nipple stimulation causes the release of oxytocin which can cause contractions.  This would be somewhat similar to being in the hospital and being given Pitocin.  However, in the hospital your baby’s heart rate would be continuously monitored while on medication, ensuring that contractions were not causing any distress for your baby.  Please do not do this if your baby is not being monitored because we would have no way to ensure that the baby is not being stressed by those contraction.  Plus, it sounds pretty painful!!!
7. Membrane Stripping: Membranes stripping is done while checking your cervix.  Your provider will separate the amniotic sac from the cervix causing the release of prostaglandins.  This really only helps induce labor if your cervix is already favorable.  Stripping membranes on an unfavorable cervix is very difficult (and painful) to do and not likely going to cause any cervical change or thinning.  Membrane stripping can cause some cramping and spotting and can also increase the chance of your water breaking.  If your water breaks or if you are bleeding and not just spotting, you should go to labor and delivery and be evaluated immediately.
8. Acupuncture, acupressure and massage: No proof that any of this helps induce labor.  However, it may provide a little bit of relaxation.  And your partner probably owes you some massage at this point ;)

So, that’s the scoop on starting labor.  For many women, the body will probably go into labor when it is ready, no matter what you do or don’t try at home.  For others, the body may need a little help to get things going, particularly if you are past your due date.  Ultimately, regardless of how your labor starts, the most important thing is a healthy baby and mommy at the end of your labor 😊

​Dr. Pam

Winter time in Idaho is definitely not for the faint of heart.  In order to really thrive here, finding a winter activity to motivate you to get outdoors is key.  If you’ve been looking for a few reasons to go outside, other than throwing snowballs at your kids 😉, here’s a good place to start.  And for the record, please don’t throw things at your kids. 

1.  Looking to reduce risk of cancer, autoimmune disease and blood pressure?  Getting outside in nature can reduce the inflammation that can contribute to these illnesses.
2. Want to score higher on tests and improve memory and focus?  Take a walk.  Being outside in the woods rather than an urban environment can improve short-term memory by up to 20% for some individuals and has even been shown to increase focus in some individuals with ADHD.
3. Looking to destress?  Being outside in wooded areas can reduce both your resting heartrate and cortisol levels, both of which are markers of stress.
4. The holidays as well as the colder, darker days can certainly be a trigger for both anxiety and depression.  For a little relief, get outside, especially to exercise, which can exaggerate the improvement for both issues.  Even just getting outside can help make us happier.
5. As winter approaches (ok, fine-it’s here), we often see an increase in the incidence of illnesses and colds.  Some new data suggests that forest environments can improve immune function, which in turn may decrease severity and frequency of viral illness.
6. Trouble falling asleep?  Camping outside (maybe not in the winter unless you’re really brave or know a really good cuddler) can help reset your internal clock to improve your sleep pattern.
7. Trying to lose a few pounds?  Those who exercise outside are more likely to stick to their routine and often see improved weight loss results compared to those who exercise indoors.  Also, those who exercise in the cold vs warm weather are more likely to burn more fat in comparison to breaking down muscle.
8. Lastly, it’s a good reason to make friends with someone who has a sauna or hot tub.  Many people find both of these activities relaxing, and some see improved muscle soreness or stiffness.  If you’re going to exercise hard in winter, why not relax hard, too?

So, what to do during the Idaho winters?  It’s easy to get outside during our beautiful summer months, whether to walk, run, bike, hike, fish, etc, but finding fun winter activities can sometimes be a challenge.  The simplest activity is going to be continuing walks, although for some days snowshoes may be beneficial.  Winter photos can also be amazing, and hiking to that perfect spot can be good motivation to get some outdoor time.  For those who are more athletically inclined, downhill or crosscountry skiing, fat-tire biking or hunting may be for you.  Snowmobiling can also be good incentive to get outdoors.  Regardless of what you decide to do, be sure to bundle up as excess cold exposure can negate the positive health benefits of being outdoors.  Not to mention, it’s hard to enjoy anything if you’re spending your day shivering.  Happy winter, and we hope to see you outside 😊

​Dr. Nick

I find that while talking to expecting moms, there is a huge interest in figuring out which newest line of baby gear will be that perfect item to help their baby sleep or the newest in baby bottle technology.   However, the focus on mom and what will help her get through that initial tough postpartum period while she is recovering from pregnancy and birth is often overlooked.  So, I took an informal poll of my new moms to see what items helped them the most after having a baby. 

1. Dermoplast was a big one.  After a vaginal delivery, a lot of women require some stitches in the perineal area and dermoplast is a benzocaine spray that numbs that area while you are recovering.   I’ve had a lot of patients specifically say that the dermoplast was a lifesaver!
2. Postpartum Corsets, bands and wraps: A lot of my patients have found relief using these postpartum to help with back support and compression until the uterus goes down to its normal size.  Bellefit was probably one of the more popular bands.  Many of my patients who have had a cesarean section just use the one that they get from the hospital. 
3. Nursing gear: If you plan on breastfeeding, make sure you have all your nursing gear sorted out prior to delivery.  Most insurances now cover the cost of pumps.  All you have to do is ask your provider for a prescription to take it to your insurance-approved location and they will give you a pump.   Research the pump that you are interested in and confirm that your insurance covers it.  Make sure you have some comfortable nursing bras on hand.  Nursing pads can be cloth or disposable.  I have found that many prefer the cloth nursing pads because they are more absorbent.  Nursing is one of those things that comes really easy to some and is really hard for some.  Some people produce lots of milk and their baby latches on perfectly.  For others it is not quite this easy.  I think the most important thing you can do is be prepared ahead of time so you are not scrambling for these items while trying to figure out how to nurse a newborn. 
4. Do I need scar cream for my cesarean section to make it less noticeable?  For most I would say no.  However, there are some people that are more prone to keloid scars.  If that is the case, I would discuss this with your provider and find out what skin closure technique they recommend to minimize scarring.  Generally, this shouldn't be applied until after the skin edges have fully sealed.  If you already have an noticeable scar, usually a revision of the scar can be done with a subsequent cesarean section to improve the cosmetic appearance. 
5. Constipation: If you are prone to constipation, then this can make the postpartum period absolutely miserable.  Make sure you drink 64 oz of water, stool softeners twice a day, and if you cant get enough fiber in your diet, be sure to start taking a fiber supplement now.

The postpartum period is really hard.  While some may feel like it’s a long vacation, the reality is you are recovering from nine months of pregnancy and birth and adjusting to the needs of a newborn.  This can be especially hard if you don’t have friends and family close by.  Hope this helps!

Dr. Pam