Ogden Nurse Midwives

Bradley Method versus lamaze vs. hypno vs...whatever?

2012-01-26T09:20:00.007-07:00

I often get asked by patients what the best method is for going "natural" during childbirth. Many patients are becoming more educated and realizing that often the things we "routinely" do in the hospital may pose added risk of c/section, infection, etc. Some of things such as pitocin use, rupturing membranes artificially, frequent vaginal checks, placement of monitoring tools internally, etc. have likely lead to some of the above mentioned interventions that are not preferable. Therefore, the trend is leaning once again toward self education and reliance that your body can do this without unnecessary interference. That being said, labor is still a painful process and is a lot of work for your body, and therefore, knowing the best option to help you cope and succeed with the delivery you desire is important!

So, first off, let's talk about the Bradley method. This came about many years ago by a Dr. Bradley and I believe it is the method most women will succeed with because it is the most normal and reasonable. I would estimate that >90% of my patients who use this method or take classes for this do succeed. It encompasses the attitude that labor and delivery are normal processes and don't usually require interevention unless necessary for the life of the mother and/or baby. Notice how I used the word "usually.." This method still requires intermittant monitoring of the baby and mom (vital signs, etc) and if abnormalities are noted, intervention may still be necessary. This method focuses much on nutrition and proper eating and weight gain for the mother. I believe this is crucial to pregnancy! They encourage 80-100 gms of protein per day...which I thought was a lot, but it certainly makes sense to help maintain sugars and help with weight gain and diabetes prevention. Plus, a normal weight infant is less likely to have or cause birth trauma than a very large one:) The Bradley method also focuses on knowing the mechanisms of labor and how your body functions, so it is less mysterious and scary. They focus on natural breathing vs lamaze which is very regimented breathing that sometimes leads to hyperventilation...which is not good for the mom or the baby. I think when you understand your body as a labor machine capable of doing this, and give it the proper diet and exercise to prepare this is the method you can and will succeed at!

Hypno birthing is also a popular method and there are many great classes and instuctors in this as well. It is more mediation, breathing, and hypnosis focused, although I've only ever had one patient I've delivered that I believe was truly "hypnotized" for her delivery. I think most women can't get that deep into their meditations and when they are not they sometimes panic and have no other information to pull from. Then they give in to medications or epidural. Both of which I think are reasonable options, but do have side effects that would not otherwise be present if they you still going "natural."
Lamaze is a bit old fashioned. Although relaxation and breathing are critical components to natural, certain altered chest breathing in rhythm and focusing on this so much is probably not the best. I think it often leads to hyperventilation which alters the blood gas of the baby and mother. This is what makes you feel "tingly" and "dizzy" both common complaints we see in hyperventilating patients. This typically leads your nurse to think you need more oxygen and they put an oxygen mask on you making the problem worse! You need to slooooow down, relax and breathe into a paper bag if necessary to take in less oxygen.
So in a nutshell, those are my thoughts on those options. I do have information on classes for all of these methods at my office if you would like more information on this.

And as always, I believe the birth experience is about you. If you choose epidural or other medications don't feel bad! Labor is hard work and exhausting and not all labors are the same. It is not a race or competition to see how much better or equal you are to anyone else who has done it. There is more than one right way to have a baby. Good Luck!

Pics of the new office for my good friend Erin in Texas and anyone else interested in looking!

2011-12-14T13:04:00.011-07:00

Nurses Desk

Staff break room

4D ultrasound room

Flat screen TV for easy viewing in 4D room

Regular exam room

Blood draw, blood pressure, and weight room

Waiting room

Front Desk

Our new office!

2011-10-29T17:02:00.003-06:00

Hey everybody! Our new office will be done this next week. Come visit us at 5285 S. 400 E. STE B. Washington Terrace. We are right behing New Image Day Spa, kiddie corner to Weber Credit Union as you are driving in on Adams Ave towards Ogden Regional.

Breast and Ovarian Cancer update...

2011-09-01T10:53:00.006-06:00

We recently had a presentation from the breast cancer/ genetic screening doctor from University of Utah at one of our OB dept. meetings. I learned a few interesting things I'd like to share, especially because I never have posted on breast cancer or ovarian cancer.

First of all, there is a fairly new law called GINA I believe. It stands for Genetic Information non-discrimination act (I believe). This law prevents insurance companies from declining insurance to you based on known genetic mutations that have caused or may cause in the future cancers, etc. This is especially important for women with a significant family risk cancer for breast cancer. We are now encouraging you to get the BRCA genetic screening test so you are aware of how at risk you may be for breast cancer and ovarian cancer as well, if you are positive for this mutation. Although it may be psychologically stressful for you to know this information, it may also be useful for to get more thorough screening such as MRI yearly for breast cancer versus just mammography. Also, if you choose to undergo a mastectomy or oopherectomy (removal of ovaries), you may be able to prevent breast and/or ovarian cancer all together. I found it quite interesting that by removing ovaries alone, breast cancer risk is reduced as much as 68%! This is due to the decline in hormones...which has it's downfalls too, but is better than getting breast cancer:) If you undergo mastectomy, your risk is reduced by 90%. Of course this is not a desirable option for some, but it is certainly something to consider in women with a strong hereditary risk and a + BRCA test.

It is important to note that regardless of family history, everybody in the general population has an 8% risk of breast cancer and this is why we encourage mammograms yearly starting at age 40. We also encourage monthly self breast exam. This entails feeling the entire breast for lumps that feel hard, non-tender, and do not move easily. It is also important to look at the breast and note any changes in skin appearance, or uneven hanging of the breast, or the nipple pulling to one side. If you have any of these changes you should see your healthcare provider right away.
It is typical to note breast tenderness and even some lumpy, mobile tissue at times such as with your menstrual cycle, or with breast feeding. Some women have fibrocystic breast tissue that feels lumpy and may require ultrasound or biopsy to decipher benign from a malignant lump.

We also recommend yearly clinical breast exam in which your healthcare provider palpates your breasts for worrisome lumps or changes. It helps to have someone trained in recognizing normal changes and typical breast tissue from worrisome changes that necessitate further evaluation.

Well, good luck with your screening exams, and as always, come in and get examined and ask questions if you are concerned about your own risks!

VBAC-Are you a good candidate?

2011-08-29T11:05:00.004-06:00

So I've had patients ask me about VBAC (vaginal birth after cesarean) and whether or not this is the best option for them. This is a one of those things that is very individual and may or may not be the right thing for you.

First of all, VBAC has risk whether you've had a vaginal delivery before or not. There is approximately 1-2% percent risk of uterine rupture (from the previous scar on the uterus) during labor and delivery. There is risk of hemorrhage and fetal death from this, as well as hysterectomy (removal of your uterus). If you choose to take this risk, it is necessary for an obstetrician to be immediately available during your labor in the event that emergency c/section and/or hysterectomy is necessary. Because of this, CNM's (in this area) do not do VBAC's. We can however see you for prenatal care and then if you are an appropriate candidate for VBAC and desire this, you can transfer to an OB willing to offer VBAC and go from there.

Secondly, are you someone that VBAC would be successful or more likely than not to be successful? If your reason for having a c/section with the first or 1 or 2 of your deliveries (no more than 2 or VBAC is not allowed due to risk) was because of a breech baby, placenta previa, non-reassurring heart tones in labor, severe pre-eclampsia or HELLP syndrome where you didn't get the chance to labor or some other reason besides failed trial of labor, then you may be a good candidate for VBAC. This is especially true if your cervix is softening, dilating, and effacing the last month of pregnancy.

If your reason for c/section was because you labored a long time ( like 24+ hours), and your cervix never dilated, or it dilated but the baby never dropped or you pushed for 2-3+ hours and the baby never descended into the pelvis enough to deliver or to place a vacuum or forceps to attempt vaginal delivery, you are NOT a great candidate for VBAC. This is a circumstance that is likely related to you having a small pelvis and trying for a vaginal delivery again will result in the same problem. Although this is not always true, (maybe your baby was larger last time or the head was not coming down straight, etc.) it tends to be more likely that you will need a c/section again anyway, and your better option is just to schedule the repeat cesarean.

The other thing you should be aware of with VBAC is that it is preferrable that you go into labor on your own, and have an epidural during labor (in case of emergency c/section). If you are dying to just be started and your cervix is not ready, you should probably be anticipating a repeat c/section.

Well, hope this helps with your understanding of VBAC. As usual, please ask if you have any other questions or concerns regarding this. I can't always remember every detail of every topic to put on this blog. This is just the general gist....

Preconception considerations....

2011-07-04T13:12:00.002-06:00

In response to Pricillas question. The major component of preconception is making sure you have folic acid in your system. It is preferred that you are taking a multi-vitamin or prenatal vitamin with at least 400-1000 mcg of folic acid per day for 2-3 months prior to pregnancy. If you have a history of a baby with a neural tube defect you definately want to be getting the higher amount of folic acid the 1000 mcg dose. This is available as a rx as well.
Having a yearly exam is good too, but is probably less important than the folic acid. The yearly exam screens for cervical and breast cancer as well as evaluating weight, blood pressure, bad habits such as smoking and lack of exercise that may put your future pregnancy in a riskier category. It is always better to start pregnancy healthy with a normal weight and blood pressure if preferred and to have already stopped smoking. We can't stress the need to stop smoking enough.
Any doctor, nurse practitioner, nurse midwife, etc. is just fine to do a regular yearly exam and hopefully remind you of of the above listed considerations. Good luck!

Alcohol and Pregnancy

2011-06-03T09:30:00.004-06:00

So to answer one of Meagans questions on the last post, let's talk about alcohol for a minute. Currently, the guidelines regarding alcohol in pregnancy are do not drink. Period. The reason is that we really do not know what amount of alcohol causes birth defects or developmental/behavioral problems later in childhood. Most of the literature suggests that hard alchohol consumption on a daily basis is the major contributing factor to fetal alcohol syndrome. However, it is difficult to do research on such a subject because no woman wants to drink regular amounts of heavy or lighter alcohol to find out later what the effects are. Further, many women probably deny or lie about any amounts they are consuming and thus would scew results. As for the question regarding wine... there are countries I've read about in Europe where pregnant women do drink 4-8 oz of wine with dinner at least a few times/week and do not have children with problems (that we know of). Thus, we believe that it likely would take heavier more regular consumption of alcohol to cause major problems. The problem is we just don't know the magic amount of alcohol that would be a problem or wouldn't be. I still believe wine is a little bit of a heavier alcohol...not like vodka or everclear, but not as low as beer. Most wine still contains 11-18% alcohol which may be enough to be problematic for a fetus especially if consumption is daily. I doubt occasional wine intake would contribute to many problems, but I can't say for sure. I think if you were going to drink something occasionally, I'd pick beer or a wine cooler because the alcohol amount is so much less. That being said, the real answer we no of for now, is no alcohol at all. That way, you don't have to wonder later if what you consumed contributed to some problem in your child should some issue arise.

Fish and Preterm Labor

2011-04-28T14:01:00.003-06:00

Speaking of interesting articles by ACOG this month- they published one that showed increased intake of fish decreases risk of preterm birth in patients who have experienced preterm birth before. They found that 2-3 servings per week of fish particularly early in pregnancy had the greatest benefit, and that eating more than that did not show any extra benefit. However eating fish less than once a month for patients with increased preterm birth risk increased their risk of preterm birth again.

It is unknown if taking fish oil capsules has the same effect as eating fish. In this particular study, the patients who were given capsules started them at 16-21 weeks gestation and this did not decrease their risk for preterm delivery. Thus, it is either important to start them earlier in the first trimester or perhaps prior to pregnancy or to stick with fish as there may be some other dietary supplement in fish that decreases the risk of preterm labor/birth.

The study did not look at other socioeconomic factors, but as I tell all of my patients, 2 servings of fish/week is reasonable and may have added benefit of reducing preterm labor.
Happy fishing!

Back to the Home Birth Topic

2011-04-28T13:22:00.003-06:00

So, recently in the May 2011 addition of the ACOG journal (American College of Obstetricians and Gynecologists) were two articles discussing the topic of planned home birth. I'd like to share some key points from their articles as things to consider with homebirth. However, it appears they have based their information off of only one study in the Netherlands and the rest of their research has to do with the physicians ethical practice of medicine and what they feel is in the best interest for patients.

They state that "planned home births were associated with a twofold increased risk of neonatal death." They further state that the cause of this may be largely in part due to distance from a hospital in the event of an emergency (many patients studied lived >20 minutes from hospitals). They also state that the majority of home deliveries there are not attended by Certified Midwives, but rather by lay midwives who lack experience and the skill to save a baby or mother if needed. They also stated percentages of complications were higher in first time pregnancies in women laboring at home versus those who had experienced other births.

The College does however, note the right of the patient to make an informed medical decision being fully aware of her risks to herself and to her baby. They also advise physicians not to participate in home birth, but to give care and advice during pregnancy despite where the patient decides to deliver and to be willing to provide emergency care in the hospital when needed if a patient participating in home birth necessitate emergency hospital care.

So here are my thoughts. I respect ACOG's present position and generally I try to follow their guidelines for care of my patients. However, I don't feel that they have enough research on other areas (like Sweden) where they have Certified Midwives providing home births in areas close to the hospital etc. I still believe there are places where home birth is safe and effective for LOW RISK women.

I've decided if any of you out there would like to try home birth, I may be willing to deliver you at home if you see me throughout pregnancy for your care, are extremely low risk and remain that way throughout pregnancy. You would also have to live within 15 minutes from the local hospitals that I have privileges at, be willing to sign arbitration and home birth consent forms and pay out of pocket for this service if your insurance does not cover home birth. Further, I will likely not exceed 2-3 home births/month as this may complicate things with my other patients, hospital deliveries, and office/clinic schedule. This is open as a trial period and I may stop if I feel it is putting you, your baby, or myself at too much risk.

I welcome all comments!

Breastfeeding

2011-02-15T20:52:00.002-07:00

Sorry I'm such a slacker at blogging. I'd like to say I'll get better, but that might be lying.

I've been thinking about topics I may have missed, and I got to thinking about one of my favorite parts of motherhood....breastfeeding. This is one of those difficult postpartum tasks that many women unfortunately give up on due to struggles with latch, pumping, etc. I'd like to encourage my patients out there to not give up! As most of you know, breastfeeding has sooooo many benefits to the baby as well as for yourself. To start with, it provides your baby with the right amount fats, proteins, carbohydrates, and water for your baby's growth and hydration. Secondly, it provides your baby with antibodies you've made towards infections which supports your baby's immune system and prevents illness in your baby. It may also decrease the risk of SID (sudden infant death syndrome) in the first year of life. Third, it's FREE! What can motivate you more than saving money on formula? I don't know about you, but that was a huge motivator for me:)

Ok, now that we've covered some benefits for the baby, let's cover benefits for you. First off, as your baby breastfeeds as a newborn, the hormone oxytocin is released in your body and this release causes your uterus to cramp and go back to it's original size. This further decreases your bleeding and risk for postpartum hemorrhage- yeah! Second benefit to you is that breastfeeding decreases your risk for breast cancer and possibly other gynecologic cancers. It may also help you lose weight faster and get back to your pre-pregnancy weight.

So why do people stop breastfeeding? The major reason I see is difficulty with latch or breast infections. One way to help encourage breastfeeding is education. I encourage my patients to take breastfeeding classes prior to delivery to learn about positioning, latch, pumping and storing milk (if you have to go back to work or be away from your baby), and signs and symptoms of infection. Fortunately, breast infections are usually easy to treat with antibiotics or creams, and if you stick it out, the infection will cure and you continue breastfeeding. Please feel free to call if you think you have an infection or need help with this. There is also Le Leche League and lactation consultants available through the hospital to help you as well. Do not give up!

Lastly, there are a few conditions when a woman should not breastfeed. If you have HIV, herpes lesions on your breast, or tuberculosis you should not breastfeed. However, most other illnesses including respiratory viruses, flu, stomach viruses, and other bacterial infections (including mastitis) are still safe to breastfeed. Many medications are also safe with breastfeeding, but check with your provider or pediatrician if you are unsure what medications are safe.

One last note- make sure you are eating plenty of healthy calories with breastfeeding. You must consume approximately 500-800 calories more per day to make milk and you must drink plenty of water- at least 8-10 glasses per day, if not more. If you begin exercising, you may also need to increase your calories beyond the 800 calories to continue to make milk. If you think your milk supply is drying up, it may be that you are not consuming or drinking enough fluids. It actually takes more calories to make milk than it does to grow a baby in pregnancy- so don't skip meals trying to lose weight. The pregnancy weight will gradually come off with time.

Good Luck!

What is the GBS test?

2010-11-03T12:54:00.002-06:00

GBS or group B strep is a pathogen that approximately 1/3 of all women carry. It is not a sexually transmitted infection and it doesn't make women or their partners sick. However, newborns born to women with positive GBS vaginal/rectal cultures are prone to sepis (wide spread infection) or illness because of their immature immune systems. Only about 5% of babies born to a GBS+ woman would actually become sick, but the illness can be so rapid and the newborn could potentially die, therefore, we perform universal testing and treatment for all women. Testing occurs usually between 35-37 weeks gestation unless preterm labor or premature rupture of the amniotic sac occurs. In the latter case we would test and treat immediately. Otherwise, we routinely swab (with a q tip type swab) in the vagina and slightly into the rectum during the last month of pregnancy. We do the rectal swab because the majority of strep actually lives in the intestinal tract and that area is still a risk factor for transmission to the baby. If the culture is positive we give intravenous antibiotics at the onset of labor and continue to give them intermittantly every 4 hours until delivery to prevent infection in the newborn.
Some patients may be positive with one pregnancy and negative with another. The reason is because strep can colonize (grow) and once it has grown to a certain level it is picked up on culture and said to be capable of causing infection in the baby. Once we treat you, it may stay at low enough levels that it is not a problem in future pregnancies. However, we will often treat anyway (especially if you'd prefer) if you have been positive with other pregnancies and negative with the current one just in case the bacteria grows in the time from doing the test to the time of labor even though current guidelines do not say this is necessary. We also repeat the test if it is negative and you don't deliver within 4 weeks to see if it turns positive in that time.
For those of you going natural and concerned about the IV with being strep positive, we recommend treating it with antibiotics and then we can hep cap your IV between doses so you can still feel free to get up and move or walk. You can even soak in the bath once you are treated (and preferably if your water bag is intact).

What's the Difference Between Doctors and Midwives?

2010-10-27T21:21:00.002-06:00

This is a question I get asked a lot by patients or potential patients seeking an obstetric provider. The answer consists of many things and some different philosophies in general. Of course, there are some midwives who practice differently, and some obstetricians who practice differently, so you can't put everyone into the same nutshell, but here are the main differences. Doctors have been to medical school and have done a residency in their specialty area which includes surgery and management of high risk medical conditions. Certified Nurse Midwives (CNM's) have received Bachelor's degrees in nursing and have most have gone to graduate schools for Master's degrees in nurse midwifery. We do clinical hours and deliveries over about 2 yrs of school which consists of clinic time managing pregnancy, primary care, and gynecologic care. We also deliver babies and assist c/sections in many hospitals. Some do deliveries in birth centers and a small portion about 4% in this country do home births. Direct Entry Midwives are midwives who have had some training usually about 1 yr and perform most deliveries at home or in birth centers. There are also lay midwives who learn the trade from experience and time with other lay midwives. They perform home births.

The general philosophy of midwives is that pregnancy and childbirth is a natural and normal process that requires care of the woman, but that less intervention usually leads to better outcomes-such as a lower c/section rate. We also focus on educating our patients about things to watch for and do during pregnancy to encourage a healthy mom and baby and vaginal birth. We offer more time during prenatal visits to educate our patients and to really take time to know them and care for them. Most of us, myself included want our patients to feel that their desires are being addressed and that we are giving our patients educated options to choose from to meet their desires for childbirth. I personally don't think there is just one way that is the best way. I think natural births are wonderful, but there are some women that do not desire this and just because you choose a midwife doesn't mean you can't use medication or an epidural if desired. We/I just want you to be comfortable and safe and feel like you had a great experience. We never put your safety on the back burner either. We do intervene when necessary and consult or manage your care with an obstetrician if things are varying from a normal safe path. That being said, most midwives have lower c/section rates, bigger babies, and less preterm delivery. Part of the latter is likely because of the education time we try to take with our patients.

Last but not least, midwives usually spend more time with you during your labor offering labor support or emotional support and advocating with the nurses and other care providers on your behalf to help you get the birth experience you want. So, if you are

considering a midwife, come on in, you won't be disappointed!

HPV AND CERVICAL CANCER

2010-08-30T13:36:00.002-06:00

HPV or human papillomavirus has 100+ strains, a few of which are considered "high risk" meaning they can cause cervical cancer. HPV is sexually transmitted, and because it is a virus, it is not curable. However, like flu virus, there is a vaccine to protect young women (and men now) against the dangerous strains of HPV. Not all HPV infections will turn into cervical cancer. In many cases, your body will take care of the virus and you will not require treatment for abnormal pap tests or cancer. However, your body may not treat all of the strains, and some of them may mutate and cause changes in the cervical cells which may lead to cancer down the road. Most abnormal cervical tests take 5+ years before they would be considered as full blown cancer requiring hysterectomy, etc. However, there are some cases that move faster and therefore, it is important to follow up with regular screenings, colposcopy, or other treatment as recommended by your provider. Further, there are other types of cancer that are not caused by HPV and that is why all women must be screened, not just women with muliple partners.
Gardisil and Cervarix are vaccines that are available to prevent cervical cancer. The vaccines are recommended for women aged 14-27. It must be given in three separate doses and most insurance does cover this vaccine, so if you fall in this age group, check with your insurance and your provider and get vaccinated! Gardisil also prevents certain types of HPV that cause genital warts as well, so if this vaccine is right for you, you may be "killing two birds with one stone!"
So....don't skip out on those yearly exams or vaccines!

Preeclampsia or (Toxemia, the old fashioned term)

2010-08-14T22:32:00.002-06:00

I just realized I've never posted on preeclampsia which is one of the number reasons why it is important to get prenatal care. The cause of preeclampsia is unknown, yet its damaging effects are well known. Preeclampsia is diagnosed by an elevation of blood pressure and protein in urine. Thus the reason for regular urine samples and blood pressure checks during your prenatal visits. There is no cure for preeclampsia besides delivery, and so the goal of treatment is to hopefully get you to term 37+ weeks gestation and then deliver. However, if it becomes severe and begins to involve other organs such as your liver, then delivery prior to term becomes mandatory. Signs and symptoms of preeclampsia are elevated blood pressure, protein in the urine, abnormal labs typically low platelets, and elevated liver tests, spots in vision and/or blurry vision, headaches unrelieved with medication, and swelling of extremities and face. It is important to note however, that swelling by itself is not diagnositic of preeclampsia as many patients believe. You must have the elevation of blood pressure and protein in urine to truly have preeclampsia. If you believe you may be having these symptoms it is important to see your provider as soon as possible or go to labor and delivery for evaluation. The worst case scenario if this is left untreated is seizures in the mother (eclampsia), stroke, or even death. In the fetus, there is risk of growth restriction, morbidity and mortality associated with preterm delivery, and death as well from vasospasm and constriction of blood flow to the placenta and therefore to the baby. So, moral of the story, be sure to keep your regular prenatal appointments, and pay attention to symptoms that could be worrisome. Hopefully, the majority of you out there will not experience this!

Glimpse of my Lake Powell vacation

2010-08-03T17:27:00.003-06:00

For those of you who want to see the good times had at lake powell last week-here you go! And yes I know it doesn't have to do with midwifery, but since I don't have a separate personal blog, I figured my friends would like to see that I do dare to go on vacation even if it's only about every 3 years!

Vitamins

2010-06-29T21:20:00.002-06:00

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!

To ultrasound or not, that is the ?

2010-06-16T21:16:00.002-06:00

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??

2010-06-16T21:05:00.002-06:00

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:)

Post partum blues/Depression

2010-05-20T12:24:00.003-06:00

I thought I should touch base on this topic, especially with all the child abuse I am hearing about lately on the news. Postpartum blues is a normal change in women after delivery that comes about due to the sudden drop in hormones at delivery. It generally causes you to be teary and emotional at things that wouldn't normally cause this reaction. The blues usually lasts only 2-3 weeks. If you are feeling this way longer than 3 weeks, or are having negative thoughts towards yourself, or your baby, you may be heading for depression. Unfortunatley, depression robs about 20% of mothers of valuable moments and bonding with their newborn. This type of depression can you leave feeling apathetic, tired, and in some dysfunctional and irrational. Although these can be devastating to your growing family, there is treatment. We frequently use medication and/or counseling in the treatment of depression. It is also important for you to share your struggles with your partner or other family or friends that can help. Sometimes the best thing for you is to have some time for yourself. Make sure you are getting out of the house, getting rest, and getting a little exercise if appropriate to do so. It is also important to note, that if you feel that you cannot handle a crying infant leave them in their crib where they are safe and have someone come help you! Babies cry and although this is frustrating, it is generally not harmful for them. If you have concerns about the crying or other medical problems, call your pediatrician.
I am always happy to talk to you and you can call our office or my cell phone for any concerns. Just know, you are not alone. Many women struggle with this and there is help... just don't be afraid to seek it!

Breech Baby

2010-03-29T12:45:00.002-06:00

Usually babies are head down by 32 weeks and hopefully 36 weeks. But if they remain breech or head up, then we have to decide what the best option for delivery is. If you have a normal uterine anatomy and your baby does not have any anomilies and your placenta is in a place that makes it safe to attempt to turn your baby, then we can schedule you for a time in labor and delivery and I will assist my OB backup physician in attempting to manually turn your baby. This is call an external version. We/he places our hands on your abdomen and try to somersault your baby into the right position. There is about a 3% risk of doing harm which would necessitate an emergency c/section. If all goes well, we monitor your baby for about 30-60 mins after and then send you home. We usually do these around 36-37 weeks when your baby is small enough to hopefully have success at turning, but old enough that survival outside the womb would be fine if you have to be delivered immediately. Your other options are to wait and see if the baby turns on its own, or you can try leaning down in the decline position on your elbows and knees a couple times a day for 5-10 mins and see if that helps your baby spontaneously move. If your baby doesn't turn and remains breech at the time of labor, you will likely need a c/section. If you think you are a good candidate to deliver a breech baby and you wish to try this, we send you to Dr. Silver at the University of Utah. I think he is one of the only OB's in Utah that will still attempt breech deliveries, as these are fairly dangerous. Otherwise we schedule you for a c/section. I have also had some patients go to acupuncturists and do acupuncture and they have had success. These acupuncturists claim to have an 80% success rate-which is pretty dang good if you think about it! Of course you check with your provider to make sure this is appropriate. If your uterus has a septal defect, or your baby has some other defect, or your amniotic fluid is low, it is best to leave things alone and have the c/section. You risk more damage to yourself or the baby to try to intervene, and let's face it, we want you to have a live healthy baby even if this means a longer recovery for you!

Vaginal Infections

2010-03-29T10:32:00.006-06:00

I thought I'd post about something different than pregnancy stuff, although vaginal infections can occur during pregnancy. There are different types of vaginal infections with different symptoms and complications. I would say this is one of the primary things we see in the clinic on a typical day. To start with, let's talk about yeast infections. Most women will experience a yeast infection at least once in their lifetime, and likely more than that. Yeast is a natural pathogen that we all have a small amount of in our vaginas. However, it can multiply and grow when other good bacteria are killed off such as when you take antibiotics. It also thrives on sugar, so people with diabetes or who ingest too much sugar may be more prone to yeast infections. It is also present in people who are HIV positive-that is another story though. Symptoms of yeast are typically intense itching and burning. Sometimes women will notice a white, curdly discharge as well. Yeast is usually easily treated with medications some vaginal, some oral-dependent on your preference. You can also naturally treat this with eating yogurt that contains live acidophilus cultures or acidophilus tablets that can used vaginally or taken orally. And then avoid excessive sugar consumption!
The next vaginal infection we see, and probably the most common is bacterial vaginosis. This is usually caused by the bacteria "gardnerella." The most common symptom is foul odor-typically a fishy odor. There is usually runny clear to gray discharge. The odor is also ususally worse after intercourse. This one is somewhat worrisome during pregnancy as it can potentially cause the water to break early and increase infection risk from that to you and the baby. This in turn will lead to preterm delivery. This may not happen to all, but it does to some and therefore, I believe it is worth treating during pregnancy especially. This is easily treated with oral pills or vaginal gels. There are also some natural remedies available to such as garlic, but I'd prefer you come talk to me about those so I can tell you how to do it correctly:) I actually think some of the more natural treatments are better especially for recurrent bacterial vaginosis.
The other vaginal infections are usually sexually transmitted. Chlamydia is the most common and unfortunately, many women do not have symptoms. Therefore, unless you come in and ask to be screened, this can be missed for some time. Gonorrhea is another one, and you may have green discharge, or some burning, or you may have no symptoms at all. It is less common than chlamydia, but we do see it and it is very important for both of these infections to be treated. Which, luckily, those two are 100% curable. However, if it isn't detected for months or years, it can lead to infertility and chronic pelvic pain. So moral of this story is, don't be embarrassed, come in and be screened for everything and avoid problems down the road. We have seen it all before, and won't be surprised!
I forgot to mention warts and herpes...also sexually transmitted infections. Herpes causes blister like lesions on the outer and sometimes inner vagina. They are very painful. It is almost always pain that brings people with these lesions in to be checked. Unfortunately, there is no cure for herpes. You will have outbreaks throughout your life. We can somewhat control and suppress these outbreaks, but you will always have the virus and can spread the disease even when you don't have lesions. We can also treat some of the pain, but the disease remains.
Genital warts are also another nuisance. These are more common than herpes, but like herpes they are not really curable. We can apply an acid to them in the office or give you a prescription for a cream to help lessen or rid of you the present lesion (s), but the virus remains. You may still have outbreaks. The good thing is, these are not painful and do not usually cause a problem with vaginal delivery down the road (which herpes can). There is a vaccine however, that can prevent most strains of genital warts if you get the vaccine months prior to the exposure. The vaccine as some of you know is gardisil, and it also protects against some types of HPV that can cause cancer. Check with your provider if you think this may be something you are interested in.
Well, I think this mostly sums up vaginal infections.

Diet, Exercise, Weight Gain

2010-03-14T21:09:00.002-06:00

So, I get asked all the time "How much weight should I gain with pregnancy?" The answer is slightly different depending on your starting weight, so here goes. If you are a normal weight and BMI (body mass index) when you become pregnant, you should gain about 25-35 lbs. If you are overweight or obese meaning a BMI greater than 26, you should gain no more than 20 lbs. If you are underweight BMI less than about 21 you should gain about 28-40 lbs. Weight gain is something I believe is so important in growing a healthy baby. If you are not gaining enough weight, you risk a small for gestational age baby or a growth restricted baby. You also increase your risk of preterm birth (which although you may not care to be pregnant anymore, this is extremely dangerous for the baby). On the flip side of this, if you gain too much weight during pregnancy you risk a baby that is large for gestational age and the baby may have difficulty regulating blood sugars. Further a large baby (usually 9 + lbs is considered large) is at greater risk of birth trauma from shoulder dystocia (meaning we get the head delivered and the shoulders get stuck). This can result in Erb's palsy which causes the affected arm to be permanently numb (some are can be temporary) and can also result in death if we are unable to get the baby delivered rapidly. It also increases your risk of more severe vaginal and/or rectal lacerations :(

Okay, so now you know the risks, what can you do to prevent them? Try to eat healthy diet full of fresh vegetables, fruits, proteins, and complex carbohydrates. Try to avoid excess sugar, soda pop, and juices. Typically if you can include a small amount of protein with each meal, you will keep your blood sugars more stable and will not have rapid drops in sugar levels which make you crave more of the unhealthy sugars that contribute to some of the above problems. Protein is found in meats, fish, beans, nuts, peanut butter, tofu, yogurt, and cheese. I find if I tell patients that are feeling episodes of dizziness to include a small amount of protein with each meal, they tend to do better.

The other thing is exercise. Although I'm not a believer that you should be out running marathons or anything too strenuous, a little bit of exercise will help you maintain a normal weight gain with pregnancy and can help you be in shape for delivery. I would recommend walking, swimming, light aerobics, light weight lifting (no greater than about 10 lbs), yoga or pilates. Exercise also increases your brains natural endorphins such as serotonin and norepinephrine making you less depressed and moody.

Well, all of that being said, genetics do play a role in the size of your baby and some other conditions that you may not have total control of. So don't beat yourself up if you have a baby less than 6 lbs or over 9 lbs, you may not have been able to help it. I'm only suggesting ways to try and have the healthiest pregnancy and birth experience for you and your baby....

Good luck!

Preterm Labor

2010-03-14T20:54:00.002-06:00

Hi everybody. Sorry I haven't posted for awhile. I just get busy with work, kids, etc. I've thought of some other topics though that might be worth writing about, so I'll hopefully get posting more regular again. I decided to start with I would do this one on preterm labor.

Many women will experience some signs of preterm labor during pregnancy, and I thought it would help to write some signs to help you decide between what is "false" labor from what is real. If you are having occasional contractions such as a few per day, this is usually nothing to worry about. However, if you feel that you are starting to have a pattern to the contractions such as 3 or more contractions per hour for more than hour you should be checked. Other signs of preterm labor include cramping (feeling like menstrual like cramps), pressure in the vagina or rectum, increase in vaginal discharge, leaking amniotic fluid, or backache, then you should be evaluated by your practitioner.

Typically, when patients present with signs of preterm labor, we run a test call a fetal fibronectin which we obtain from a vaginal swab. If this test is negative, there is a 99% chance you will not deliver for at least 2 weeks. Thus, this test is very indicative. However, if it is positive, you won't necessarily deliver early, but we will be more aggressive in our treatment to prevent preterm birth. Treatment is usually aimed at stopping contractions and thus slowing cervical dilation, and at buying more time for fetal maturity. We stop contractions with medications, and bed rest, as well as hydration. We also give you injections (steroids) to aid in fetal lung maturity in the event that your baby is born early. If you have had a history of preterm labor or preterm birth (preterm being less than 37 weeks gestation) we also may start you on progestone shots at about 17 weeks until 36 weeks. Although this doesn't always prevent preterm birth, there is some good evidence that it may delay it and allow more time for fetal maturity.

So, bottom line, make sure you tell me or your practitioner if you are noticing signs of preterm birth or if you have a history of preterm birth....hopefully we can have a better outcome than before!

Merry Christmas-you better not pout!

2009-12-19T10:13:00.002-07:00

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

Contraception Options

2009-12-18T10:22:00.002-07:00

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?

2009-12-18T10:15:00.002-07:00

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.....

2009-12-17T10:14:00.003-07:00

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.....

2009-12-17T10:09:00.002-07:00

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

2009-11-07T07:04:00.002-07:00

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

2009-10-12T13:03:00.002-06:00

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

2009-10-08T13:01:00.002-06:00

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

2009-10-05T11:34:00.002-06:00

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

2009-09-30T13:40:00.002-06:00

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!

2009-09-29T15:33:00.002-06:00

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.