pregnancy, Women's Health

Top Treatments for Nausea in Pregnancy

The majority of women will experience at least occasional nausea during the first trimester, with about 2% experiencing severe daily vomiting. Symptoms usually peak at around 10 weeks as pregnancy hormone levels peak and then slowly improve over the next few weeks.

Because morning sickness is usually at the top of a mommy-to-be’s list of concerns, I wanted to offer my best advice for dealing with this unwelcome side effect of pregnancy.

As a starting strategy, eat small meals throughout the day. Stop before you are full, and try to eat again before you are hungry. High carbohydrate meals seem to be the most helpful. Sucking peppermint candy has been shown to reduce nausea after meals. Keep crackers beside your bed so you can eat them before you get up in the morning. Getting up very slowly can also be helpful.

Some women will have specific foods or smells that trigger the nausea. If you know what the troublesome foods are then you can plan ahead and avoid them. In general steer clear of spicy, rich or fried foods. Other women will experience nausea with brushing their teeth (but please don’t avoid this one!) or other activities like pumping gas.

Try to to take your prenatal vitamin at night with a small snack.  If the vitamin still causes nausea, then switch to one without iron.  It is very important to get adequate folic acid during the first trimester. So if you can’t hold down an entire vitamin, try a folic acid supplement.

If the nausea is not improving, the next option would be a combination of Vitamin B6 (10 mg) + doxylamine (10 mg…like Unisom) taken every 6 hours as needed. It is safe and is available over the counter. Obviously a sleeping pill may make you tired, but it does help the nausea. Natural ginger supplements have been shown in some studies to reduce nausea. Dramamine “natural” is a ginger supplement that you can find at most pharmacies.

Another great option is the Relief band.  It is a medical device that is worn on your wrist that feeds an electrical impulse through the nerves in your arm that modulate the nausea centers of your brain and stomach. It is FDA approved and drug free. You do need a prescription from your provider.  Several of my patients have gotten significant improvement from this device.

If you’ve tried these tips and you’re still vomiting regularly or find your nausea incapacitating, then please call your doctor’s office. There are several prescription medications that can help reduce the nausea.

Reasons that you may need to be seen urgently are: vomiting blood, dehydration that results in decreased urination, or not being able to hold down anything for 24 hours.  Please let your provider know if you have these symptoms.

I found nausea to be the most challenging symptom in my own pregnancy. I found that keeping snacks close by during the day was helpful. At times, I took the anti-nausea medication in order to function and found it helpful. I would love to hear from our readers about any other helpful hints or products they found beneficial.

As always, we encourage you to discuss these remedies with your doctor so together you can determine what is best for you.

 

pregnancy, Women's Health

SEX AFTER BABY: WHEN DOES IT GET BACK TO NORMAL?

When I see moms at their 6 week postpartum visit I discuss resuming sexual activity. As I broach this topic, I am greeted by a variety of responses, as different as the women themselves. Some laugh and say they have already resumed activities and all is good. More often, they give me a blank stare that says, “Are you kidding? I haven’t slept in weeks. I am constantly coated in spit up and you want me to think about nookie?” Whatever their initial attitude, I know that statistically by 3 months postpartum 90% of women have resumed sexual activity.

After you are fully healed and resume activity there is still a transitional time until things return to your new normal. Notice I said ‘new normal,’ because after children everything is different. Not necessarily worse or better, just different. If you keep waiting for your love life to be exactly how it was before the baby, you need to adjust your ‘sex-pectations.’

Before you resume intercourse, it is important to be cleared by your doctor that all is good ‘down there’. If you resume activity before you are fully healed it can prolong the healing process.

Will sex hurt after having a baby? If so, for how long?

This depends on the type of delivery. Most women experience some discomfort for 3-6 months. A vaginal delivery with no tears and a cesarean section without labor usually have the least pain. More severe vaginal lacerations often take the longest to fully recover, up to 6 months.

The most common types of pain are burning with insertion and sharp pain with deep thrust. The pain should get better with time and practice. Regularly using a water based vaginal lubricant during the postpartum period is a must. If deep pain is an issue, trying positions were the woman controls the depth of penetration is key.

While breastfeeding, the body’s estrogen levels are low, leading to vaginal dryness and decreased lubrication for a lot of women. If you continue to have pain and dryness despite lubricant, see your physician.  A small amount of estrogen vaginal cream can be prescribed to help restore your hormonal balance and improve lubrication.

When will I get my ‘groove’ back?

The most common sexual issue that women have postpartum is a lack of desire. The incidence of low libido at 6 months postpartum is 44%.   However, only 10% reported being bothered by their lack of desire. For a lot of women, just knowing that it’s normal to not feel like swinging from the chandeliers when they are 6 months postpartum, is reassuring.

Usually after the first couple of encounters the pain will decrease and you should enjoy lovemaking again. If you enjoy sex when you have it and it doesn’t hurt, that’s a great start.  It’s OK that you don’t necessarily spend all day thinking about it.

Attempt to set aside a scheduled day and time for intimacy. Notice I said ‘intimacy’ and not just sex. For women, it is important to have time to connect with her partner, to help her feel more amorous.  And for any guys reading this: helping with the laundry and letting the new mom take a nap is the BEST form of foreplay.

OK. It’s been 6 months and things STILL aren’t good. What’s next?

If at six months you are still having pain or not enjoying sexual intimacy then it is time to see your doctor.

Depression. If in addition to lack of sexual desire, you are also not enjoying any other hobbies, are feeling down and having crying spells, this could be a sign of postpartum depression. Talk about these feelings with your doctor.

Medications.  Certain medications that treat high blood pressure, depression and contraceptives can affect sex drive.  If you are on medications, do not discontinue abruptly but instead talk to your doctor to determine if these could be affecting your libido. If so, request a change to an alternative treatment.

Fear of pregnancy. When you have been up all night with a colicky newborn, if you do start to feel a little amorous, the thought of getting pregnant again can sometimes be enough to nix any ‘vavoom’ that you had percolating. Women often fear contraceptives might effect their breastfeeding, but there are multiple options that are both safe and effective.

While it’s normal to not feel super sexy in the postpartum phase, things will get better. Most women are back in the swing of things by about 3 months, but if you continue to experience pain and lack of sexual enjoyment at 6 months, follow up with your doctor for help.

(Originally posted on the Pregnancy Companion Blog)

pregnancy, Women's Health

Should I Get Membranes Stripped?

“Would you like me to strip your membranes? It hurts, but it might help put you into labor”  is a question I often ask when a woman’s due date has come and gone.

The patient will usually pause and mentally weigh the misery of her current pregnant state versus the suggested discomfort of said, ‘membrane stripping.’

“How exactly do you do it?” she will inquire skeptically.

I explain. When I check a woman’s cervix, I insert my finger through the cervix to touch the bag of water and/or babies head. By doing this I can determine the dilation (how open the cervix is) and effacement (how thin it is). To strip (or as some more nicely say it, ‘sweep’ ) the membranes, the finger is inserted further in the uterus and rotated in the space between the bag of water and the uterus. This causes the release of proteins called prostagladins which help bring on contractions. Studies show that membrane stripping has a 20% chance of bringing on labor within 24 hours.  It may be as high as 50% if combined with intercourse (semen also contains prostagladins).

Membrane sweeping is not an induction method, it’s a way to get the body to kick into labor on its own. It does not increase the risk of infection, but like I said, it does hurt. How much? Every woman’s pain tolerance is different, but I’ve heard nice Baptist girls curse after a good sweeping.

After having your membranes stripped, you will likely have some spotting and mucous discharge for about 24 hours. This of course, totally puts you in the mood for the aforementioned ancillary to the sweeping: intercourse.

If your overall pregnancy misery outweighs the temporary discomfort of membrane stripping, you may just want to go for it. No, we can’t be for sure it will work, but it may help.  I would advise to not shorten the term to just ‘stripping’ as the following quote was overheard in my waiting room recently, and was a little disturbing:

“Doctor Rupe is great. She does the best stripping, it puts me into labor every time!”

pregnancy, Women's Health

TOP TEN TIPS FOR TWIN PREGNANCIES

Telling a couple that they are having twins is one the best things about my job. Watching their faces as the meaning of my words takes effect is priceless. With twin pregnancies on the rise due to increased use of fertility medication and older maternal ages, I get to tell the exciting news often. Currently 3.3% of births in the US are multiples.

Luckily in this age of ultrasound technology, women usually know fairly early in their pregnancy, so they can start planning right away. Here are some helpful hints for those who are going to be needing a double stroller:

TOP 10 TIPS FOR TWIN PREGNANCIES

1. Eat for 3. Twin pregnancies require an additional 600 calories a day. So a 5′ 5″ women who weighs 140 at the start of her pregnancy will need about 2500 calories a day. That doesn’t mean 2 extra Snickers bars. Focus on getting your 5-7 servings of fruits and vegetables a day. Also, eat lean proteins throughout the day to help prevent hypoglycemia. A prenatal vitamin with at least 1 mg of folic acid and an iron supplement is encouraged for all twin pregnancies. Weight gain is recommended to be 37-54 pounds for a mom with an normal BMI.

2. Don’t fret your belly size. In The Pregnancy Companion, we talk a lot about worrying over your belly size. ‘Helpful’ friends and neighbors tend to constantly comment on the size of your belly. One neighbor comments you are too large, later the same day a co-worker will think you are too small. It’s also hard to not compare yourself to other preggos who are at the same point in their pregnancy. The shape of your pregnant belly really depends on your body type and how many babies you have had. If this is your first pregnancy and you are tall with a long torso and firm abs, you may not show until after 20 weeks.  If you have a short torso and this is your third baby, you may be in maternity clothes before you get out of the first trimester. Your doctor will be monitoring your size carefully, so listen to her, and not your mother-in-law.

3. Stay active as long as you can. Gestational diabetes is caused by the placenta secreting an anti-insulin hormone, so with twins you have twice the placenta and therefore an increased risk. Twins do often mean bed rest later in pregnancy, but not always.  Stay active as long as you can to help keep up your muscle tone and reduce your risk of gestational diabetes. Stay in communication with your doctor about your amount of activity. Even if your pregnancy is complicated by partial bed rest, ask your provider if you can continue yoga and pilates to help reduce back pain and hopefully maintain  muscle tone.

4. Buy Tums in bulk. Most pregnancy symptoms are amplified in twin pregnancies. Heartburn tends to be one of the worst. Often women will go directly from their first trimester nausea to heart burn.  The hormones of pregnancy cause relaxation of the valve between the stomach and the esophagus. Add in that two babies are pushing your stomach up towards your esophagus instead of just 1, and you get a wonderful burning sensation in your chest complete with disgusting sour taste in your mouth. Tums are safe in pregnancy but you will often need stronger meds, so talk to your provider if Tums isn’t holding your symptoms.

5. Lay on your side. It’s usually recommended to start sleeping on your side after 20 weeks, but with twins 16 weeks is more realistic. The growing uterus can compress your blood vessels, reducing the blood return to your heart, and making you feel weak or dizzy. Swelling may also start earlier than normal. Stay active, reduce high-salt foods and invest in compression stockings early on.

6. Prepare early. 60% of twin deliver before 37 weeks, but luckily only 10% are born before 32 weeks, where the major complications of prematurity usually occur. Schedule your baby showers early and try to have your nursery ready by 30 weeks. Have a few preemie outfits on hand, but keep the tags on all clothes since you are not sure what size they will be when you bring them home.

7. Accept all help. I know people always say this, but with twins, this is REALLY true. Start a list of things you will need: dinners, laundry, diapers. When anyone asks what they can do to help, even if you don’t think they mean it, assign them a task.  If it’s someone you don’t really want coming to your house to scrub your tub, ask for diapers. If you can in anyway afford it, budget for a housekeeper during the first 2 months postpartum. I think this goes for all pregnancies, but for twins especially.

8. Find your support system. Whether it’s your MOPS group, Sunday school, family or neighbors, know who you can count on for help. Seek out other moms of multiples before delivery to find out tips. Meet Up, Google, Facebook are all at your fingertips to find groups of moms who know what you are going through.

9. Find good resources. Those who follow the blog know that I had a twin adoption fall through. During the months that we were preparing to parent twins I read multiple books. The best was Juggling Twins by Meghan Regan-Loomis. This book is absolutely hilarious and chock full of helpful hints, from pregnancy through the toddler years.

10. Don’t let twice the babies equal twice the worry. As soon as you find out you are having twins, most of you will immediately hit Google. This will fill your mind with all the complications that can happen in twin pregnancies. Twins are high risk. Your doctor will watch you closely to make sure the babies are growing well. She will watch for preterm labor and high blood pressure. Twin pregnancies have bumpy parts and miserable moments, but 90% of twin pregnancies do make it past 32 weeks, resulting in healthy happy babies.

pregnancy, Women's Health

THE BEST TIME FOR BABY #2. . .

With all of my patients, as they enter the third trimester, I discuss what their contraceptive plans are for after the baby is born.

Many smile a beautiful, blissful, glowingly pregnant smile and say, “Oh no. I don’t think we will ever use contraception again.  Hopefully we will get pregnant again right away!”

Fast forward to their postpartum visit. A sleep deprived, exhausted new mom sits before me. Her first topic of conversation: contraception.  While she is madly in love with her new baby, the thought of having another right away is a little overwhelming. She is not physically ready to go down that road again.

Some women are ready right away. I once had a women ask me at delivery when she could try for another baby. My answer, “Well, you at least have to wait for me to get the placenta out!”

The decision on when to try for your next child, obviously depends on many factors. Finances, age, personal goals and beliefs on contraception are just a few. I was recently asked on our FB page what the ideal timing between pregnancies is from a medical stand point. According to studies looking at pregnancy outcomes, it is best to conceive 18 months to 4 years after your last delivery.

I find it interesting that the ‘optimal’ time for conception of the next child is about 18 months since this is when children are truly at their most adorable. Full of toothy grins and giggles as they toddle around.  This stage of ultimate cuteness entices people to have another baby. They then proceed to conceive before their child hits the ‘terrific twos.’ Which while adorable, at least in my house, is a challenging time.

Pregnancies conceived less than 18 months since the last delivery have an increased risk of preterm delivery and low birth weight. Pregnancy takes a lot out of your body, and it takes time for a woman to recover from the stress and for her nutrient supplies to get back to normal. The theory is that the body has not fully recovered at less than 18 months causing the baby’s extra risk of not growing as well (low birth weight). The risk of preterm delivery is further amplified in teens who conceive again quickly, since teens have often used their nutritional supplies on their own growth as well as their baby’s.

VBAC: Women who attempted a trial of labor after a cesarean section have an increased risk of uterine rupture if the pregnancies are less than 18 months apart.

Pregnancies conceived less than 12 months since the last delivery have an increased rate of placental abnormalities, such as placenta previa and placental abruption. Placenta previa is a condition where the placenta covers the opening of the cervix making vaginal delivery unsafe and increasing the risk of hemorrhage. Placental abruption occurs when the placenta begins to detach from the uterus before the baby is delivered.  It can result in hemorrhage and fetal distress.

Pregnancies conceived less than 6 months from delivery have an increased rate of neural tube defects and autism. Neural tube defect is associated with low maternal folate levels, so most likely in pregnancies less than 6 months apart, the mother has not had time to fully replenish those supplies.

Pregnancies conceived greater than 4 years from the last delivery  have an increased rate of preeclampsia, fetal growth restriction and cesarean section. It is unsure why this increased risk is seen other than the possible health changes in the mom over this time.

The actual ‘increased risk’ in each of the cases is statistically significant but overall low for the average woman. Take preterm delivery, the risk increase with conceiving early is 20%. For the average mom with no history of preterm birth, this changes her risk from 1% to 1.2%, which is negligible. However, a woman with a previous preterm delivery sees her risk go from 15% to 18%. These increased risks are most significant for those moms who already have risk factors for these conditions.

For the average healthy mom with no medical problems and a vaginal delivery, the increased risks of these complications with conceiving again soon are extremely low. Women with a cesarean section should wait 18 months for their scar to fully heal, especially if they desire a trial of labor (VBAC). Those with a history of pregnancy complications listed above are advised to wait the suggested interval before conceiving.

pregnancy, Women's Health

IF MY TODDLER JUMPS ON MY PREGNANT BELLY, WILL IT HURT MY BABY?

Being pregnant with number two (or three. . .) can be an entirely new ballgame. Each pregnancy is different, so you may be experiencing random new symptoms that vary from last time. Likely, you are also feeling much more tired than with your first baby, because now you are chasing around a toddler instead of getting some occasional rest. You are also learning to play defense with your pregnant belly, attempting to keep baby #1 from clobbering it on a regular basis. Despite your best efforts you will occasionally get bumped, pulled on, and likely even body slammed hard enough to take your breath away. This can be scary and painful to the mom, but is extremely unlikely to hurt the baby.

Your baby is protected by many layers:

Bones

Skin

Fat

Muscles

Fascia (strong connective tissue that holds muscles together)

Intestines

Uterus (super thick and strong muscles)

Any blunt force has to pass through all these insulating layers to reach the baby. But even then, the baby is further insulated by the amniotic fluid.

In the first trimester the uterus has not even reached the pubic bone, so the pelvic bones protect the baby.

Many moms often wonder if tight clothes, seat belts, a toddler sitting on her lap, intercourse or pushing on their abdomen might harm the baby. Please rest assured these activities are not going to cause any issues.

To injure a baby in the womb, it takes a significant amount of force. Most cases of fetal injury are due to domestic violence (gunshot wounds/stabbing) or car accidents.

What can be concerning is shearing forces, especially in the third trimester. The placenta is made to detach from the uterus after delivery, but strong shearing forces can make it pull away prematurely. Falls onto the abdomen or buttocks, car accidents or severe trauma can cause the placenta to be dislodged from the uterus in a condition called an abruption. An abruption can happen immediately after trauma or may not show up for 24 hours after an accident. Symptoms of an abruption include:  contractions, bleeding, and abdominal pain. Anytime you fall during pregnancy, if it’s hard enough to knock the wind out of you, you should call your provider. Even if you don’t fall directly on your abdomen it is important to be monitored for signs of an abruption.

Testing for an abruption includes an ultrasound, labs to check for bleeding, and monitoring contractions and baby’s heart beat. Often we will monitor women for up to 8 hours after an accident to make sure that there is no evidence of an abruption.

The unavoidable day to day bumping and pushing on your pregnant belly is fine. The occasional toddler hop, though painful and stressful for mom is unlikely to injure your baby.  The baby will just be sloshed around in his amniotic fluid swimming pool. If you fall or are involved in any type of auto accident, this could be a major issue. Please call your provider to determine if you need further evaluation.

pregnancy, Women's Health

8 MEDICALLY PROVEN TIPS FOR MAXIMIZING FERTILITY

Statistically more babies are born in October than any other month of the year. Actually the entire fall is crazy busy throughout the maternity ward. That means a lot of you are likely considering getting pregnant right now. The internet is chock full of ‘hints’ on improving fertility, but it is loaded with an equal amount of anxiety-provoking misinformation as well.  So what really works and what’s merely an old wives tale? Here’s what the most recent studies say:

1. Have sex

Have sex everyday or every other day for 5 days before and 5 days after ovulation.  Ovulation usually occurs  2 weeks before your period starts. Do not have sex more than once a day, as that can lead to diluted semen.

Things that do not effect chances of conception:

  • Female orgasm
  • Sexual position
  • Female position after sex

NO, it will not help if you stand on your head afterward. Neither is there a top secret magic sexual position that improves your chances of getting pregnant.

What may effect conception: lubrication. The best lubricants for fertility are canola oil, mineral oil or Pre-Seed.

2. Don’t smoke

Smoking is the culprit for up to 13% of all cases of infertility. Either partner’s smoking can effect their ability to conceive. The effects of smoking on your reproductive system can take up to a year to be reversed. There are so many reasons to quit smoking, but here is another excellent one: it can help make you more fertile.

3. Maintain a healthy weight

A BMI between 17-27 is ideal for conception. Recent studies report >60% of the US population are overweight. In some instances, being overweight can lead to higher insulin level, which can inhibit ovulation. This is a condition know as PCOS. (I did an entire series on it in the fall). In other instances, overweight women will have regular cycles (meaning they are ovulating) but still be subfertile. The good news is that even a modest weight loss of 10% of body weight can improve fertility.

Being too thin can also lead to subfertility. Your body senses that you don’t have enough reserves to handle the added nutritional demands of a pregnancy, so your brain tells your ovaries to shut down, causing your periods and ovulation to cease. This is often seen in cases of eating disorders.

4. Exercise in moderation

For women with a BMI of >25, exercise was found to cause a slight improvement in fertility. However women with a BMI of <25, who exercised vigorously > 4 hours a week were found to have a slightly decreased fertility.

Much like being too thin can shut down ovulation, extreme athletes like marathon runners and dancers can go through times of no cycles (no ovulation) when training intensely.

A man’s level of exercise has not been shown to effect fertility, with the one exception.  Men who bicycle > 5 hours a week were found to have lower sperm counts.

5. Healthy diet

Is there a magic food that will make you pregnant? No. However there have been several large studies looking at the diets of women with a history of infertility who become pregnant.

The dietary recommendations based on this study:

  • Get the majority of your protein from plants
  • Eat high fat dairy food
  • Take a multivitamin with iron
  • Eat complex carbohydrates

Another smaller study has supported the Mediterranean Diet to improve fertility.

Celiac Disease (gluten sensitivity), if undiagnosed or untreated, can lead to infertility. The treatment for gluten sensitivity is to follow a gluten  free diet.

6. Limit caffeine

It is recommended to limit caffeine to less than 300 mg a day. Here’s a helpful chart to know how much Starbucks you can drink.

7. Alcohol in moderation

While a little wine might be helpful in conception (wink-wink); excess intake may inhibit fertility. Studies show that consuming >14 alcoholic drinks a week has an adverse effect on fertility in both women and men. Consuming 3-13 drinks per week had a a slight negative effect on the woman’s fertility in some studies; but none on the man’s. Three or fewer drinks a week had no effect on fertility. There is no safe amount of alcohol in pregnancy, so once the stick turns pink, then you should abstain completely.

8. Know when to see a physician

Most couples will conceive within 6 months of trying, with 85% becoming pregnant within one year. If you are less than 35 and have regular menstrual cycles (every 21-35 days), it is recommended to see a doctor if you haven’t conceived after one year of trying. If you are over 35, it’s recommended to see a doctor after 6 months of trying.  If you do not have regular cycles or if you experience severe pain with your period or intercourse, you should see a doctor right away.

There is not a magic formula for conceiving. No magic food or sexual position that guarantees quicker results. What does work best is being healthy and regular sexual activity.

Hopefully your journey to pregnancy will be a smooth. Check out this previous post on recommendations for the first trimester once you do conceive.

In the meantime, enjoy the process!

Motherhood, Women's Health

HOW I CAME TO BE AN OB/GYN

“You must have the grossest job in the world. Why on earth would anyone want to be a Gynecologist?” my twenty something patient asked, as I was examining her ‘nether regions’.

“Well, I do enjoy helping people” I lamely replied. I was doubtful she heard me, as she had already returned back to texting at this point.

I smiled as I left the room, remembering my surprisingly similar thoughts at her age.

I wanted to be doctor for as long as I could remember. But when I started medical school, the two specialties I knew I didn’t want anything to do with were OB/GYN and Pediatrics.

There was little doubt in my mind that Family Practice was my chosen path.  I chose Oklahoma State University because of its focus on primary care. I had shadowed several FPs and truly enjoyed the continuity of care and relationships that occurred in Family Practice.

When I started my rotations as a third year student, I excitedly picked FP as my first month. The practitioner I worked with was amazingly kind and knowledgeable.  He also had a passion for teaching and I was appreciative of the time he spent instructing me. Though we saw some interesting patients, there was also a lot of mundane colds and earaches. After about 3 weeks, I started to have doubts whether this was really what I wanted to do for the rest of my life. I was a little concerned, but knew I had a few (our school required 6 months of Family Practice) more months to decide.

The next month, I did an away rotation in internal medicine with a wise internist who had been in practice for 30 years. While I didn’t love internal medicine, I did love the doctor. I soaked up every bit of wisdom about life and medicine he sent my way. He inspired me to THINK and not just memorize facts. On my last day of the rotation he sat me down and said essentially that I had done well on the rotation, but he thought my personality was the most suited for OB/GYN.

I smiled on the outside, but internally I rolled my eyes.

My first thought was, “What a sexist!” I was sure he was saying that merely because I was a woman. OB was becoming a female dominated field, and it had been commonly suggested for me to consider it. However, the last thing I could possibly be interested in was doing PAP smears all day. Yuck. Child bearing had no interest to me whatsoever. It was WAY too messy.

I composed my initial thoughts and replied, with a simple, “I don’t think so.”

“When’s your OB/GYN rotation?” he asked.

“The last one of the year.” I replied, having postponed it to the end.

“You should seriously consider moving it up earlier” he encouraged me.

I thanked him for his advice as a courtesy. Then thanked him profusely for the other things he had taught me.

On the drive home I was still fuming about his remark. However, my thoughts began to wander. His wife and all 3 of his daughters were doctors, but none OB/GYNs. There were no other sexist things he had said or done the whole month.  I respected him greatly and had trusted all the other advice he had given me. Perhaps, I should listen and at least move my rotation up to earlier in the year. After all, I wasn’t loving FP nearly as much as I thought I would.

After several frantic phone calls, I managed to set up a rotation with a local private practice doctor, in desperate need of some CME’s.  I ‘did’ very little during this month, but what I observed was life changing.  I observed his daily practice: his rapport with his patients, interesting procedures and complex diseases.  He was able to practice preventative medicine in a real way (one of my passions) and also do fascinating surgeries.  I witnessed babies born then later the same day the removal of a giant ovary full of teeth and hair from another patient. It was thrilling. On my last day of the month, I broke down in tears on the way home. I couldn’t believe my month was over. I didn’t want it to end. I had fallen in love with the crazy life of being an OB/GYN.

Then began the soul searching and prayer. How could I have a family and be an OB/GYN? As much as I loved my month of OB, the hours were harsh, and I wasn’t sure I could hack it. Was being an OB really God’s plan for me or just a selfish whim? After months of pro’s and con lists and long discussions with my husband, I finally felt a peace from God that this was the path I should take.

Finishing my last 6 months of family practice rotation only confirmed my decision.

This life is NOT easy. The hours do get crazy. Yes, there are days when I do get tired of looking a vaginas all day long. But the longer I do this job the more I love it. So here I am, 8 years into private practice reflecting on how my life is nothing like I expected it to be when I began this crazy adventure in medicine. I realize that it is amazingly better.

Thank you Dr. Bruns for telling me I should be an OB/GYN. You were right.

pregnancy, Women's Health

WHEN IS IT “SAFE” TO TELL PEOPLE YOU ARE PREGNANT

I was at an end of the year kindergarten party this week. After consuming the usual amount of sugary snacks associated with such class parties, but before saying their dramatic goodbyes that also included full body hugs, each kindergartner circled up to say what they were looking forward to most this summer. Most announced various beach and Disney trips, but one little girl began jumping up and down and squealed, “I’m excited about summer because my mommy has a baby in her belly!” Based on the way her mom’s eyes widened and jaw dropped open in horror, I’m guessing this new baby news was not yet meant to be public knowledge.

It’s hard to know when it’s ‘safe’ to tell people you are expecting. In this age of social media, it is difficult to tell just family and close friends. Even when you try to keep it quiet, the news has a way of sneaking out like it did for my friend whose great aunt had recently joined “The Facebook” and accidentally posted her congratulations on her wall instead of a private message.

Everyone’s biggest fear is making a big public pregnancy announcement, only to have to sadly announce a loss a few weeks later. With my first pregnancy, we called all our friends and family the day we found out. We simply couldn’t contain our excitement. Sadly about a week later, we experienced a loss. It really stunk having to then tell everyone we had a miscarriage, but at least people knew why I was sad and could offer their sympathy and support, which was very helpful. With the next pregnancy I was very guarded and waited until after 12 weeks before I shared the news.

When I see a couple for their first pregnancy appointment, after we see the heart beating strongly on ultrasound and they breathe their initial sigh of relief, one of the first questions they ask is “Is it safe to tell people we are expecting?” I get a sense they feel that if I give them the blessing, all will be OK. While I can never offer a guarantee, I can offer statistics that provide some reassurance as to when it’s safe to let all their great aunts know the exciting news.

Chance of miscarriage after a normal first trimester ultrasound (maternal age <35):

  • At 5 weeks the risk of loss is 8%
  • At 6 weeks the risk of loss is 7%
  • At 8 weeks the risk of loss is 3%
  • After 12 weeks the risk of loss is < 1%

While many women choose to wait until after the first trimester to tell their news, if the baby has a normal heart beat at 8 weeks, their chance of a normal pregnancy is 97%.

Risk factor that might increase the chance of miscarriage:

  • Maternal age >40
  • History of >2 miscarriages
  • Diabetes
  • High blood pressure
  • Lupus
  • Untreated thyroid disease
  • Abnormally shaped uterus

Sadly, miscarriage is very common with up to 15% of pregnancies ending in loss. This rate can increase an additional 10- 25%  if you count “chemical pregnancies,” when a woman’s initial home test is positive only to have her cycle start a day or two late. Due to the high rate of chemical pregnancies, I encourage my patients not to rely on ultra sensitive home tests days before their period will normally start, but instead try to wait until they are at least a week late.

The decision of when to announce your pregnancy is a very personal one. I was initially horrified when I realized I was going to have to “unannounce” my first pregnancy after my loss, but eventually I was thankful I had the support of all my friends as my heart was healing. For those looking for the best time to share your news, know this: the risk of loss drops dramatically once you have seen a healthy heart beat, and then becomes extremely low after the first trimester. 

Motherhood, pregnancy

My Birth Story

When my alarm began blaring at 5:20 am on January 21, 2004; I immediately hit the snooze button. I am normally a morning person, but the last few weeks of my pregnancy were beyond exhausting. As I reluctantly climbed in the shower I purposefully avoided the mirror. I really didn’t want to catch a glimpse of my giant whale body. I had stopped feeling like a ‘cute pregnant lady’ long ago. My feet where still swollen from the night before; I noticed my sock indention from the previous day’s work.

I was lucky. My pregnancy was healthy and had gone quite smoothly, with the exception of one small hiccup: at 32 weeks I learned that my son was breech, and he never flipped. My c-section was scheduled for 39 weeks. If I am completely honest with you, I was more afraid of a vaginal delivery than a c-section. A small part of me was slightly relieved that things would be nicely scheduled and I would never have to face all the drama of labor.

My parents had their plane tickets to Ohio. It would all happen in 2 more days.

I was in my OB/GYN residency training during my pregnancy. I worked 80 hours a week, often 12 to 14 hour days. Residency was challenging enough when you weren’t carrying around 50 pounds of extra baby weight and having to pee every 5 minutes. However this was my final day of work. Tomorrow I would take an exam, then the baby would be here on Saturday. It was surreal to know exactly when the baby would come. I couldn’t wait to meet baby Ryan (we didn’t know if it was a boy or girl, but the name was to be Ryan either way).

My last day at work was not an easy one. I was assisting with several surgeries and it was during the first case that the headache started. As the afternoon progressed, I started seeing little spots. I knew these were the sign of preeclampsia, so I stopped by labor and delivery to have my blood pressure checked. It was dangerously high. I wanted to go home and get my things, but my fellow residents insisted I stay and get blood work. “Really, I’ll be fine” I said. I had no insight. Intellectually I realized I had preeclampsia, and shouldn’t leave the hospital when my blood pressure was sky high, but it didn’t compute emotionally. It was strange. There was also an element of denial at play. This could not be happening to me.

I had seen patients act this way many times and assumed they were non-compliant. I realize now when patients have an irrational response to an emergency that it is likely denial more than ignorance. So often we spend so much time picturing and planning how our special day is supposed to happen that when things go awry, it zaps the wind from our sails and leaves us stunned in disbelief.

My doctor arrived and decided the c-section should be done immediately and a magnesium drip would be started to treat the preeclampsia and help control my blood pressure. I attempted to argue that I really didn’t need it. Magnesium was a miserable drug. She just glared at me, “Of course you are getting magnesium.” I took a deep breath and complied.

After several blubbering phone calls to friends and family, they set me up for delivery. My mom didn’t get to be there, but my husband and friends (fellow residents) were there to support me.

As they wheeled me into the cold OR, I realized I was terrified of the “unknown” despite doing hundreds of c-sections myself. As I lay strapped to the OR table, I felt vulnerable and afraid. It was so awkward to be on the other side of the knife. As the surgery got underway, though I felt more calm; comforted by the familiar sounds of the instruments and operating room banter.

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As he was born, the entire room cheered. “It’s a boy” someone said. My husband and I were overwhelmed with joy.

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As the doctor held him up over the blue sheet for me to see him, I remember thinking that he looked blue and they should really get him to the warmer. Myself, my husband and my friends (who we’re running various cameras) we’re all crying and cheering. It was an amazing day.

As I held him in recovery and nursed him for the first time, I remember thinking how incredibly blessed I was. I couldn’t believe how deeply I could love this sweet little boy. What an amazing gift.