Category: Just For Fun

What to Pack for the Other "Labor Day"!

8/28/2018

We get this question from new moms all the time- what should I take to the hospital for me and my newborn? There are hundreds of sample lists online and most are so long, it would probably require you to have to “check a bag”! In reality, your hospital room isn’t very large, and overpacking in a tiny room will likely be more of a hassle, not to mention make it less likely to find what you really need. Here is a list of essentials of what moms really need for the big day:

1. Most importantly, bring ID and your insurance card. Important phone numbers written down for your nurses are also very helpful.

2. If you are a first time mom, labor can be a very lengthy process. Unless you are okay with watching talk shows and reruns of The Big Bang Theory, bring your own entertainment: Ipads/Laptops- a way to watch movies, read books, music playlists and keep friends and family updated on social media! Hospital guest wi-fi may be slow and unreliable, so you may want to download certain books and movies before your big day. Also, decide how you are going to capture that special moment- if it is a special camera/video, make sure you bring chargers/extra batteries for ALL of your electronic devices.

3. Moms, the hospital already has a lot of pads and underwear, but bring a robe, comfy sweat pants or pajamas, and flip flops (They may also serve the purpose of shower shoes!). Nursing tops and bras are good ideas, but the hospital already has breast pumps/nursing pillows if you need it. Your milk may not come in until you leave the hospital, so bringing your own is likely unnecessary.

4. For your little one: The hospital will provide diapers/wipes/suction bulbs/blankets/bottles- pretty much everything you will need for your newborn, so don’t waste space or energy packing any of these. All you really need is a couple of cute outfits that you want to take baby's first pictures in.

5. With that being said, don’t forget your toiletry/makeup bag so you can look great in those first pictures with your baby!

6. Also, you should pack at least one extra set of clothes that will fit you after you deliver. After all, who wants to go home with their butt hanging out in the breeze from their hospital gown?

7. Last but certainly not least, the car seat! Learn how to use the car seat before you leave for the hospital so you are not struggling the day of discharge.

Fortunately, no matter how hectic your “labor day” is, you won't forget the most important part of your list..your baby :)

Dr. Pam

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

8/7/2018

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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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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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Slimy, Green, and a Guardian for Your Baby: Meet the Mucus Plug!

4/18/2017

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I can’t begin to count all of the phone calls I’ve received from moms-to-be who have just passed their mucus plug, and there’s generally some amount of anxiety to every one of those calls. Don’t get me wrong, if something that looked like that came out of my body anywhere but my nose, I’d be pretty freaked out! So, let me explain a little about what exactly a mucus plug is and what it does.

What is that thing?! The mucus plug serves as a seal for the cervix once pregnancy is established, and it generally looks kind of like “snot,” although it may be pink, grey, or clear. Think of it as the “caulk” that occludes the opening between the amniotic sac and bacteria in the vagina. This helps to minimize the risk of infection in the uterus during pregnancy both by sealing the opening as well as via antimicrobial properties.

When it comes out, is my baby going to fall out, too? Regardless of whether this is a hopeful question (please say my baby’s coming!) or fearful question (my little one isn’t ready to come yet!), the answer is still the same. Passage of the mucus plug happens when the cervix either thins or dilates slightly, and the timing of when a woman passes her mucus plug in relation to when she actually delivers can vary A LOT. For some women, it can be a sign that labor is imminent, but for others, this can happen weeks before labor occurs. That’s usually when I see this face :(

Can losing the mucus plug ever mean anything bad? It can if you’re also having contractions, heavy bleeding or your water breaks. The difference between the mucus plug and when your water breaks is both the consistency (the mucus plug is thicker) and the volume (the mucus plug is generally only a few tablespoons in size vs a constant “flow” or big “gush” when your water breaks). In that case, be sure to contact your doctor or go to labor and delivery. Oh, the labor and delivery nurses asked me to inform you that you are not required to bring your mucus plug with you to labor and delivery. They’ll take your word for it :)

There you have it! Now you know all about your mucus plug and how it affects pregnancy. If you pass yours, keep in mind that it doesn’t always signify the baby is coming immediately, nor does it mean that you will instantly develop an infection inside the uterus; however, you should probably take some precautions such as avoiding intercourse, swimming or other activities that may introduce more bacteria into the uterus. If you do have questions about your mucus plug or your pregnancy, be sure to ask your provider for more details, and remember, no matter how ugly the mucus plug, the baby will always be cute :)

Dr. Nick

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Lotus Birth: Does Not Cutting the Umbilical Cord for Days Benefit My Baby?

2/28/2017

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1. First of all, what is a lotus birth?
Usually, the dad or someone present at the birth would cut the umbilical cord from the baby within a couple minutes. A "lotus birth" involves leaving the placenta attached to your baby and letting it fall off naturally. Letting it naturally fall off can take anywhere from three to ten days! So basically you have to cart the placenta everywhere you take the baby.

2. What are the purported benefits of a lotus birth?
Proponents of the lotus birth concept claim that by leaving the placenta and umbilical cord attached to the baby as long as possible, there is a decreased chance of infection where the umbilical cord is clamped. However, the placenta is particularly prone to infection since it contains blood (a great medium for bacteria to grow in). By leaving the placenta connected to the baby for long periods of time, there is actually a higher risk of transfer of infection from the placenta to the baby.
Another proposed benefit is that by leaving the cord attached to the baby for a long period of time, this allows for complete transfer of cord blood and all those nutrients to the baby. So, the umbilical cord usually stops pulsating between 3-5 minutes. Are there benefits to delayed cord clamping? The answer is yes, but for preterm infants. Delayed cord clamping usually involves waiting between 25 seconds to 3 minutes in preterm infants. Studies have shown that delayed cord clamping in preterm infants has resulted in fewer blood transfusions, a 50% reduction in intraventricular hemorrhage (brain bleeds, which are common in preterm infants) and necrotizing enterocolitis (a disease which can destroy the wall of the intestine). Delayed cord clamping in term infants, however, was actually associated with increased need for phototherapy for jaundice and an increased risk of polycythemia, especially in locations at a higher altitude. So if delayed cord clamping is not of any benefit for term infants and can potentially be harmful, can you imagine what benefit leaving your baby attached to dead placental tissue with no circulation for ten days could be? Not to mention the odor as the placenta begins to rot and decay!

3. So what do other mammals do?
Do they allow their young to be attached to the placenta until it falls off naturally? No, they eat it! The major reason mammals eat their placenta is because they are trying to avoid having a bloody temptation for predators next to the mother and baby.

If you decide you want to proceed with a lotus birth, you can purchase a lotus bag- a cotton lined bag with drawstrings with an earthy print. It's available on Etsy for $67.69, and it comes with an herb mix for the odor. Also, don't forget to give the placenta a salt bath, which helps reduce the odor and helps with the drying process.

Dr Pam

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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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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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How to Survive the Holidays with your Sanity and your Waistline Intact

11/22/2016

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As Thanksgiving nears, we begin to look forward to a season of delicious foods, family visits, and presents; however, the stress of the holidays can definitely affect one’s ability to enjoy and reflect on the blessings of the season. In a departure from routine, here are a few suggestions gathered from a variety of publications to on how to make the most of this special time of the year.

Winter in general tends to make me sad. Why? You’re not alone. Seasonal affective disorder (SAD) affects as many as 10% of people in some parts of the country, particularly in areas where winter weather is more severe. Symptoms include depression, fatigue, oversleeping or overeating, and social withdrawal. The cause for SAD is uncertain, although reduced sunlight and an evolutionary response to expected food shortages during the winter in human prehistory are thought to play a role. Current treatments include increasing light exposure either naturally or with artificial sources (light therapy), exercise, vitamin D and/or melatonin supplementation, increasing supportive social interactions, prescription SSRIs or some combination of the above. That means, even the most annoying relatives can sometimes be beneficial for your mood :)

That being said, some of those relatives really drive me nuts, and the anxiety of being the perfect holiday host really is a nightmare. What can I do? The first step to limiting some of the stress of the holidays is managing expectations. Believe it or not, those “perfect” holiday gatherings your remember from your childhood probably weren’t that perfect either, if you really stop to think about it, and it certainly won’t be the end of the world if the stuffing turns out a little dry or your father-in-law and your uncle have a rather “passionate” discussion about the election outcome. Sometimes, those unplanned memories are the ones that make the holiday special.

Other potential stress reducers involve delegation of responsibilities (certainly make your signature dish but maybe your mother-in-law can make that green bean casserole you hate to make anyway), scheduling separate gatherings for family members who really can’t stand each other (your mom as thankful for your dad’s new wife as he is), scheduling some activities to get the family out of the house for a bit (shopping, movies, ball games, etc.) and remembering that it’s ok to take a few minutes for yourself, too (you’re the host, not the concierge). Even when you think there’s not a solution to how to manage family or cook the perfect turkey, someone has probably already figured it out for you, so ask a friend! Or, if that doesn’t work, there’s always the Butterball hotline (seriously!!) to answer all of your turkey cooking questions :)

Lastly, is there a way to make it through the holidays and still fit into my pre-Christmas clothes? While the temptation is there to graze through the holiday season (personally, my kryptonite is gingerbread...mmm...what was I talking about again?) and ignore your weight until January, there are steps you can take to limit the damage. Just Google healthy Thanksgiving sides, and you’ll get a huge list of recipes. Although that being said, quinoa stuffing may not be the biggest hit at your holiday gathering. Alternatively, just remember the words “portion control.” Just because you can eat that third slice of pumpkin pie doesn’t mean you’ll enjoy it. The average American consumes roughly 4,500 calories at the Thanksgiving meal alone (just half of that is more than adequate in day), and here’s how they get there: stuffing (500 calories per cup), green bean casserole (there are beans in there somewhere, right?), mashed potatoes (400-600 calories depending on butter, gravy, etc), apple pie (400 calories per slice before whipped cream), cornbread (200 calories per slice), mac and cheese (the “winner” at as many as 1,000 calories per serving), canned cranberry sauce (110 calories per 1/4 cup), and sweet potatoe casserole (450 calories). All that cream, gravy and butter? No wonder Thanksgiving veggies taste so good!

Any final tips? Try to get outside! While not easy at this time of year, if you can find the winter activity you love, it can help with decreasing the effects of SAD, decreasing stress, and mitigating the effects of those extra sweets. Whether walking, jogging, skiing, snowmobiling or even just chasing your children with a snowball (sometimes a stress relief on multiple levels), finding your favorite winter activity can help to round out your best holiday season yet :)

Dr Nick

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Blinging out Your Lady Bits: Waxing, Vajazzling, Piercing and Other Women’s GYN Modification from Your Ob/Gyn’s Perspective

8/30/2016

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I can’t tell you how many disclaimers I’ve heard from women prior to their pelvic exams. “I’m bleeding, haven’t had a chance to shave, etc.” are common disclosures before I do pap smears. Believe it or not, unless a woman is pregnant or just in for a quick annual exam, I expect there to be some kind of change to have brought her to the office, and as long as she’s bathed that day, there’s generally not an issue. After thousands and thousands of exams, I’ve seen countless self-modifications in grooming, piercings and body art. Unless you’ve misplaced something in yours (where’s my comb again?) or had a truly unique example of body art (ie, a vagina with an owner’s manual), it’s unlikely to make an impression. So, let me tell you a little about some of the more common things we see and our perspective on them.

Au natural: For those women who opt out of hair removal, that certainly makes sense from an evolutionary perspective. Pubic hair may have evolved to help keep dirt out of the vagina, warm the genitals, or for pheromones. There is no shame in this management as it is the natural look. The only time it would be an issue is if it reaches a length to braid since it can catch in the speculum (ouch!), or after a vaginal delivery and laceration repair (long hair can get tangled in the suture, and if you ob/gyn has to trim it in order to finish the repair, we are definitely NOT your local spa, so there may be some uneven edges). We also do some trimming with clippers prior to cesarean deliveries.

Waxing: A very common management for women. Generally neither particularly beneficial or harmful from a health standpoint; however, the microtrauma from frequent hair removal may predispose to folliculitis or occasionally cellulitis requiring antibiotics as well as susceptibility to herpes infection. If this is your preference, and you aren’t having problems, then go for it! If you are requiring frequent trips to your doctors office for symptoms and still want some control over your pubic hair, then clipping may decrease your symptoms in comparison to waxing or shaving.

Vajazzling: In case you’ve missed it, the trend of applying Swarovski crystals to freshly waxed skin has become something of a phenomenon. While this can help your mons be all matchy-matchy with your favorite 90s jean jacket, the application of adhesive glue to freshly waxed skin does provide an increased risk of trapping bacteria in the follicles, which in turn predisposes to infection. Also, it seems like it would be little uncomfortable for your significant other.

Labial and Clitoral Piercing: According to some women, these piercings can enhance their sexual experience and orgasms, and others feel a bit more naughty or adventurous after having these piercings placed. For clitoral piercing, it is often preferable to pierce the clitoral hood rather than the clitoris itself to decrease (NOT eliminate) the risk of nerve damage. If you’re interested in heavier bling, the labia can accommodate larger jewelry, although this may predispose to stretching. However, even for women adventurous enough to give this process a try, there may not be enough skin available to provide a safe piercing. As far as safety goes, allow adequate healing time after the procedure, be sure to use a reputable piercing store (to minimize, although not eliminate, risk of infection), and make sure to pick a low-allergen material. Obviously, it has baseline risks of bleeding, infection, nerve damage (among others) as well as possibility for traumatic removal if caught on clothing or during intercourse. Also, the piercing would need to be removed during delivery of a baby or surgery. Lastly, be aware that depending on location of the piercing, condom perforation may be an issue predisposing to unwanted pregnancy or transmission of STDs.

Douching: The practice of using various chemicals to “clean” the vagina. Per the American Congress of Obstetricians and Gynecologists, this practice should be avoided in favor of mild soap and warm water for vaginal cleaning. Health risks of douching show increased rates of bacterial vaginosis, pelvic inflammatory disease, difficulty conceiving, ectopic (tubal) pregnancy and even cervical cancer. Also to be avoided is placing anything you may eat in the vagina. Regardless of what Dr Oz may say, a tampon soaked in yogurt doesn’t necessarily help with yeast infections, particularly if you don’t know how to take it out (and wait a few weeks to have it removed because you’re embarrassed). I was tempted to mail that one to him and suggest a part 2 episode on how to remove tampons.

Thus concludes your friendly ob/gyn’s perspective on some common genital modification techniques. So, please don’t stress before your next pelvic exam, it’s all good!

Nick

What to Pack for the Other "Labor Day"!

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

Vaginal Kung Fu: Apparently, It’s a Thing

Slimy, Green, and a Guardian for Your Baby: Meet the Mucus Plug!

Lotus Birth: Does Not Cutting the Umbilical Cord for Days Benefit My Baby?

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

How to Survive the Holidays with your Sanity and your Waistline Intact

Blinging out Your Lady Bits: Waxing, Vajazzling, Piercing and Other Women’s GYN Modification from Your Ob/Gyn’s Perspective

What to pack for the other Labor Day!

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