Tuesday, June 29, 2010


I am a huge believer in vitamins. Here are just a few thoughts on what I think are the most important vitamins to take on a daily basis. First-a multivitamin. These have all the basic vitamins and minerals you need to meet the majority of the daily recommendations. Second-calcium. The reason for the calcium is that most women will suffer some degree of osteopenia later in life which leads to osteoporosis. Most of us (men included even though they won't admit this) don't get enough milk or other dairy products to make up the amount of calcium and vitamin D that you need. Multivitamins have some calcium (usually about 400 mg/day) but not enough to prevent osteopenia. The recommendation is that we get 1200-1500 mg/day of calcium and that those supplements need to have Vitamin D. Researchers are finding we are very deficient in vitamin D and taking extra in these supplements will not lead to overdose (even though Vit D is fat soluble). Further many mood disorders such as depression can be helped somewhat with vitamin D supplements. If you are worried about your vitamin D levels, come in and we can draw blood to test this if you desire. The third daily supplement I recommend is fish oil. I think 2-3 capsules/day is recommended. These can promote normal cholesterol levels to prevent heart disease. It also helps the neurons or neurotransmitters in the brain so you can think and process information better and helps your nerves (I'm not sure the exact etiology of this off hand, but you can research this further if you desire).
I usually take this little cocktail at night all at once because this is the only time I remember, but it is probably better to take at least 1 or 2 capsules of the calcium in the morning and a fish oil in the morning and the other capsules and vitamin at night. I'm sure as long as long as you are getting the amounts in your system though, it is better than not at all.
I also recommend an extra folic acid pill if you are trying to conceive. They are finding more neural tube defects and perhaps if we get people taking closer to 1 gm of folic acid prior to conception this rate might be lower. Folic acid is water soluble so don't worry about overdosing on this if you are taking it with a multivitamin.
There are other herbs, etc available too that I take at times including garlic, and echinacea. These are not FDA approved but I think in small amounts can have some reasonable benefits. Well, happy vitamin taking!

Wednesday, June 16, 2010

To ultrasound or not, that is the ?

Our office offers ultrasound every visit. We have found this to be a very satisfying thing for patients to see their baby and have a better idea of their baby's growth, amniotic fluid, position, and even facial pictures via our 4D scan. I do have patients question the safety of this now and then though, so I thought I'd address this. Doing ultrasounds every visit (if desired) is not necessary, and doesn't necessarily mean your care is better than another office that doesn't do them. Years ago, some research suggested that too frequent of ultrasounds may result in growth restriction in the fetus or left handedness (oh no!) in the fetus. It also suggested that there is an increase in cesarean section in those with frequent ultrasounds. Further evidence later refuted that and said this could not be proven (besides the increase in cesarean section during labor from continuous monitoring-which is another story). So, because ultrasound has been around for so long and there is no good research to prove it is doing harm, we offer them regularly. However, you do not have to have them every visit. I still have the good old tape measure for your belly and doppler to check fetal heart beat if you would rather do this method. I do believe ultrasound is nice to have at least one per trimester for the following reasons. First trimester-to accurately assess your due date by your baby's size. Second trimester-to make sure your baby is anatomically normal with no lethal defects. Third trimester-to check fetal position to verify your baby is head down for delivery and to assess amniotic fluid levels. All the other in between ultrasounds unless specified for other follow up reasons, are basically for some growth assessment and for fun. Ultrasounds are also good for some situations too such as the overweight patient who a normal fundal height measurement is not as accurate. This is especially true for them because obese patients are more at risk for a fetal death so I think more regular ultrasounds to check for growth and blood flow in the cord is not a bad idea.
Now for the reason why continuous fetal monitoring in labor is an increased risk for c/section. Babies in labor typically have some decelerations in the heartbeat from umbilical cord compression or from head compression coming down the birth canal. Sometimes, we (providers and nurses included) interpret these decelerations to be more harmful than they might actually be, and we jump to do c/sections in the hopes of saving your baby or preventing cerebral palsy. Oddly enough, despite all these c/sections and continuous ultrasonic monitoring in labor, the cerebral palsy rates have not declined and the c/section rates have only increased. Thus, it may be better to have intermittent monitoring. Of course, this is only possible if you are not on pitocin and an epidural as these may increase your risk of having more or worse decelerations in the fetal heart rate necessitating a c/section. C/sections are not all bad of course. There are definite reasons to have a c/section such as a prolonged deceleration, or other more serious types of decelerations (that are not all caused by pitocin use:). Anyway, just more blah blah blah for you on ultrasound usage and the pros/cons. Hopefully, I'm not boring everyone to death.

Home Birth??

Since the last reader inquired about home birth, I've been giving this idea some thought. This is not something that I've done before but I'm starting to consider the idea of doing a few maybe. I would have to talk to my malpractice insurance company and my back up obstetrician and see if these are things that they would cover. One of the problems is if I have a patient at home and at the hospital in labor at the same time. I think the situation would depend on the time and the risk involved in any particular pregnancy. I still believe it is safer in most situations I'm delivering in, to be in the hospital. That being said, most low risk pregnancies that deliver at home (approximately 90%) are free of complications. However, that 10% or so still makes me a little nervous. To date, I have had no intrapartum fetal deaths, still births, major maternal complications, etc. and I'd really like to keep that record. Of course I've had hemorrhages and other more minor complications, but they've all been fairly treatable because I've had help for the baby and medications, etc. right there in the hospital with extra staff available to assist. That being said, I do believe in a women's right to choose her birth experience and that she has intuition about her own abilities and situation, and if home birth is something she is adamant about, maybe I should look into this? I'm just wondering how many patients or readers out there in the Weber County area would genuinely be interested in home birth if I offered this to certain patients who met a certain criteria?...ie very low risk! Please send me your thoughts, I'd be interested:)