Merry Christmas-you better not pout!

Aren't my girls cute in their matching Christmas dresses? Just thought I'd throw this in....

Contraception Options

There are many types of contraception. Some are more effective than others. Some are hormonal, some are barrier methods, surgical, etc. The most effective method next to permanent sterilization is the IUD. There are two types of IUD. The Mirena (most popular right now) is an IUD with the hormone levonorgestrel in it. It is a very low dose progestin that is absorbed only in the uterus (very small amounts may be present in the rest of the body). It keeps the uterine lining thin and the cervical mucus really thick so sperm cannot swim past the mucus to fertilize an egg. The thin lining of the uterus could also prevent implantation if a sperm and egg were to meet (although this isn't usually the case), and it prevents heavy menstrual flow if any. About 4 out of 5 women with this IUD do not have periods which is nice for many women. It is very safe even for women who have history of migraine headaches or blood clots (reasons for not using a combination pill). It is 99.9% effective and easily removed when pregnancy is desired. It takes about 5 minutes to place and is best put in about 8-12 weeks postpartum. It is minimally painful-mostly cramping at the time of insertion and otherwise is not usually painful and requires no upkeep so to say. It is good for 5 years.

There is also the copper T IUD which is made of copper and works by creating an environment that sperm cannot survive in (so similar to the Mirena). It is non-hormonal and will not change the regularity or flow of menses. Your body will be doing what it typically does menstruation wise. It is also 99% effective and good for 10 years, and easily removed if pregnancy or another method of contraception is desired.

Both IUD's are safe with breastfeeding-I forgot to mention that:)

There are hormonal methods such as birth control pills which cannot be taken with breastfeeding except for one pill (mini pill progestin only which is about 80% effective). Pills if taken everyday correctly are about 97-98% effective and they will regulate monthly bleeding.

There are progesterone only methods such as implanon which is a rod we place under the skin in the arm. It is good for 3 yrs and is about 99% effective. It is good for breastfeeders or for young girls that want complete protection from pregnancy, but are not good candidates for IUDs due to multiple partners or never having a child. It will not help with period regulation though. People on implanon do complain about irregular bleeding. The Depo shot is like this, but you come in every 12 weeks for a shot. It has the same side effects as implanon and the same effectiveness. Some people complain about weight gain and acne with Depo, however.

There are also female and male condoms that are in the range of 85% effective if used correctly. I'm guessing my readers know how those work:) They are safe with breastfeeding and don't interfere hormonally with your body, although intercouse can't be as sporadic-you have to plan a little more with this method.

There are more permanent options too such as tubal ligation or vasectomy. I usually don't recommend unless you are over age 35 and know that no matter what life deals you, you would not ever have another baby. Although these procedures can be reversed, it does not always work and is very, very costly! You are better off just doing an IUD which is as effective and easily reversed. Surgery is good however for some people that it would be way too dangerous for them to have another baby or they are older and really know that they would not want another child!

Are you in labor?

When to go to the hospital is a question I get asked all the time. The answer is somewhat different for different people. It depends what number of baby it is for you and how fast your other labors were. If you are someone that delivers in less than 4 hours or so, you should probably go when you are having contractions 10-15 mins apart for an hour and if they are painful. If your labors are longer, or if this is your first baby, then wait till contractions are 3-5 mins apart (counting from the start of one to the start of the next), for an hour or two. If you are on a second baby, things usually are about half the time of your first, so you may want to go when contractions are 5-8 mins apart. You should always be feeling your baby even during labor so if you are concerned about movement, then go to the hospital. Also, if your water breaks, or if you are feeling pressure in your vagina, pain down your legs, or pain in your back, you should go to the hospital. Some bloody discharge is also normal during labor and is another indicator of your cervix opening and time to go in. Most contractions that are actually changing your cervix are painful, hard to breathe through, and don't stop even if you stop. If you take a warm bath and re-hydrate and are still contracting and painful, you should be checked.

BORED.....

So, to be honest, I'm a little bored with my own blog. I want it to be professional with good information, but I'm not sure what topics people are really interested in. I could make it more personal too if anyone wants or we could make more of a discussion/interaction kind of thing. If anyone reading this has any suggestions on what they would like me to talk about or post on, please let me know!

Infertility thought.....

So one of my patients re-sparked my interest in infertility. Usually I get caught up in checking for problems that would cause infertility, but for patients out there that we cannot find a good reason for not getting pregnant within 1 year of trying, I have a book suggestion for you. This is only a suggestion and not a substitute for a formal consultation or lab work, but I read this back in midwifery school a few years ago and it does have some good thoughts. The book is called "Getting Pregnant the Natural Way," by Feingold and Gordon. I have it available to borrow at times or you can probably buy it for low cost on amazon.

Good luck!

Swine Flu Update

Swine flu seems to be more on the rise as winter is progressing. The great thing however, is that we have the vaccine now! As many of you are aware, we do have the H1N1 vaccines in our clinic. The majority of our pregnant patients have received the vaccine and we have had no adverse reactions to the vaccine so far. If you would like the vaccine please feel free to come on in and get it! We are also offering it to our postpartum patients. The injection is safe with breastfeeding and may be the only way a baby under six months can get immunity (as babies unders six months cannot receive their own vaccine)- so moral of the story, get vaccinated, and stay well!

Common Concerns During Pregnancy

Nausea and Vomiting: Some nausea and vomiting is normal especially during the first trimester. However, if you are unable to eat or drink for 24 hours and are not urinating, please call or go to the emergency room. There are some medications that are available to help with nausea and vomiting, but if it is severe, there are associated risks of dehyration and electrolyte imbalance that may require further treatment.

Spotting and Cramping: Some cramping may be normal. If you are spotting or bleeding heavily though, this is more worrisome of a miscarriage and requires follow up. Some spotting in the first trimester or after intercourse may be nothing to worry about. If you experience this, try resting or stopping the activity. Although miscarriage cannot be prevented in the first and sometimes second trimesters, please let your provider know so we can follow up appropriately for your individual needs.

Contractions: Irregular "Braxton Hicks" contractions are common in the second and third trimesters. If you are less than 36 weeks and contracting 4-6 times per hour please see your provider or go to labor and delivery to check for preterm labor. If the contractions are irregular/occasional, and not painful, these are usually not concerning. If you feel you may be in labor, try drinking a glass of water, taking some tylenol or a warm bath. If the contractions do not subside, please come in and be checked.

Constipation: This is a lso a common problem in pregnancy due to the growing uterus and hormones that relax the body to maintain pregnancy. Try drinking more water, eating fresh fruits and vegetables, increasing fiber and getting a little exercise (such as walking or light swimming). You can also try over the counter dulcolax, a stool softener to help with constipation.

Activity: Some activity and exercise is safe and recommended during pregnancy. These activities include: walking, light weight lifting < 15 lbs, low impact aerobics, and swimming. Other activities should be avoided such as: high impact aerobics, heavy weight training, snow and water skiing, horseback riding, four wheeling, tanning beds, and amusement park rides (basically anything fun!).

Traveling: Generally, traveling during pregnancy is not a problem. If you are close to your due date (within one month) it is less recommended. If you are going to be confined to a vehicle or airplane for more than 1-2 hours, you should stop and/or get up and walk around for a few minutes to decrease your risk of a blood clot. It is also important to stay hydrated during traveling and to wear your seat belt!

Inspiration for Today

Hello again,

I'm sure some of you out there follow the "nienie" blog, but if not you should! This is the blog of an amazing Mother who was in a near fatal plane crash over a year ago. She has made an amazing recovery from severe burns and is back to blogging about her kids, the crash, and all the things she is up to now. Her strength is so inspirational to me, I want to pass it on to all of you. I know this doesn't have that much to do with midwifery, but I watched her on Oprah yesterday and I felt a new rejuvination as a mother. I think she really captures the joy and beauty of motherhood and makes you want to be a better mother despite its difficult moments. Her blogspot is "nieniedialogues.blogspot.com" if you care to read some interesting and uplifting entries!

Safe Medications to take in Pregnancy

I Get a lot of questions about what medications are safe to take during pregnancy. I have a form typed up that we give you at your first prenatal visit, but I will write them here too so here goes!

For common cold and flu: Tylenol (acetaminophen) plain not mixed with other cold remedies.
Sudafed, plain no other ingredients (buy OTC at your pharmacy)
Robitussin DM
Saline Drops
Benadryl
Cough Drops
* Do not use ibuprofen in the last trimester and do not use aspirin at all unless I have instructed you to do so and in what amount!

For Indigestion and Heartburn: Tums, Liquid antacids (Mylanta), Pepcid AC, and Zantac
Sometimes just a glass of milk does the job too!

Diarrhea: Immodium. Try the BRAT diet too (bananas, rice, applesauce toast). Avoid spicy or greasy foods and fruit juices as these may worsen the diarrhea.

Constipation: Colace stool softeners (Dulcolax), Dulcolax or glycerin suppositories, and Metamucil or fibercon tablets. Drink plenty of water and eat plenty of fiber and fresh fruits and vegetables.

Vaginal Yeast Infection: OTC Monistat 3 or 7 day cream. You can call me as well and I can call you in a prescription too.

Hemorrhoids: Preparation H or Tucks pads. I can also call you in anusol suppositories. Sometimes a warm bath will provide relief as well.

This is just a small list of medications for common pregnancies concerns. Please feel free to call me for any other questions on medications not listed here or for severe symptoms of illness.

Swine Flu

So I decided to have the topic swine flu be one of the first posts on here since it seems to be what all the hype is about right now. We had a meeting about this with all the other OB docs in town last week and have come to a consensus about how to manage this in pregnancy-as some of you have seen coming into the office. The chief of OB at McKay-Dee (Dr. Kammeyer) showed a study that was from the "Lancet" journal that had statistics for the mortality rate of swine flu in pregnancy being 50% (of course this was a small study and not from Utah). However, we have had pregnancy cases here in Ogden with extremely ill patients, one of which was even in the ICU on a ventilator. Because of this, we are taking the swine flu very seriously and doing all we can to prevent our pregnant population from acquiring this. You will see our signs in the office about no children during your visits or even during your birth during this winter season. This is only for 4 months or so and is to protect you and your newborn baby, not to annoy you! The best way of course to protect yourself (besides getting the vaccine) is to wash your hands and avoid sick people, or stay home if you are ill. I know some of you are worried about the swine flu vaccine being a new vaccine, but I have to say that the injection is a dead virus vaccine, not a live one, so you will not become ill from it. Flu vaccines are new every year. Each year they formulate a vaccine off of what they believe the flu virus will be like for that year. These are safe vaccines and swine flu is no different. It's just a different strain of a virus. Please consider getting the vaccine when it becomes available. If you are experiencing sore throat, fever, cough, or body aches, please call our office at the onset of symptoms and we will call you in a prescription for Tamiflu (an antiviral medication). If you have been exposed to swine flu we can also call you in the same prescription but the dosing will be different. If you are having difficulty breathing, please go to the ER. I take the health of you and your baby very seriously and hope you understand the reasons for limiting visitors, etc. this flu season. I will hopefully have vaccines by mid to late October. In the meantime, get your regular seasonal flu vaccine, wash your hands, get plenty of rest, try not to panic, and enjoy your pregnancy!

Welcome!

Hello Everybody!

I am writing this blog as a way for patients and friends to be able to interact with me and with each other mostly for pregnancy related questions and concerns as pregnancy and the birth of a baby is such a life changing event. I figured I should get with the program and become more cyber savy (so to say) as this seems to be the way of the world right now. I assume most of you go to the internet to look up medical information anyway, so why not hear that information directly from your provider versus just "googling" it? Now you'll have a way to look at some common concerns or receive support during your pregnancy from the internet and know it's coming from a reliable source. You can feel free to comment or email me as well or any other "bloggers" that come to this site. I'll try to have updated information on here as well as general information and I may post some gyn stuff from time to time too. Well, I hope you enjoy this blog and that it comes in handy with any questions you may have.