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Pregnancy
So much attention goes into preparing for labor and delivery. I'd like to take a minute and focus on the next important period: the postpartum period. With forethought, preparation and help, the postpartum period can be made enjoyable and smooth.
First you needs to know what to expect in the postpartum period. Next, you needs to know how to prepare for it. Finally you need to know when to reach out about concerns and questions.
Do you know about VBAC, TOLAC and RCS? Obstetricians love acronyms. The website section about C sections has been updated and expanded to include a comprehensive section on VBAC (vaginal birth after C section), TOLAC (trial of labor after C section) and RCS (repeat C section). Go to the general C section page, then scroll down to the part on Repeat C sections and VBAC.
Click HERE to learn more about this hot alphabet soup.
Two thirds of American women will delivery vaginally. It varies, state by state from a high of about 40% to a low of about 23%. What accounts for this? Although the matter is complex, suffice it to say it is all about the labor. When we follow the course of a labor, we are following many things: cervical dilation in cm, effacement, and the descent of the baby into the pelvis. We are also tracking the contraction pattern as well as the fetal heart tracing and maternal vital signs.
To learn more about Labor and delivery, Click HERE.
Induction of labor is a hot topic. Some patients are dead set on avoiding it and some are begging for it. Induction of labor simply means using medicinal or mechanical means to start labor before it has on its own.
Inductions may be elective (by choice) or medically indicated. They may be accomplished by a variety of medicines and techniques. Induction of labor is an important tool in the Obstetric tool box.
Get a balanced perspective on induction of labor HERE.
Blood Pressure. We all know it can be a concern. But what is it really? Why is it such a concern in and out of pregnancy ?
Our entire body is fed by a system of pipes from large to tiny, which is pressurized by the pumping of the heart. Plumbing is a good analogy until you realize these aren't ordinary pipes. Most of these pipes are capable of changing their diameter, and thus their pressure within, in response to fine chemical signals. And they are pipes, which like ordinary plumbing, can build up sediment and develop blockages. They can even weaken and leak. Blood pressure is the pressure of the blood flowing in these pipes.
Fluid balance, hormone, and immunologic changes of pregnancy have great sway of the blood pressure of a pregnant woman. If she happens to have the type of body which has tense stiff vessels even outside of pregnancy, that is, if she has chronic underlying hypertension, so much the worse. She will be prone to conditions like preeclampsia, also called toxemia.
Click HERE to learn more about this fascinating and important area of Obstetrics .
Consider the standard prenatal visit. Sometimes I think it doesn't seem like we do much. We obtain weight and vital signs, dip urine, and measure the belly in a decidedly 19th century way, with a tape measure. But we learn more than you might imagine. We can get a sense of whether the baby's interval growth is tracking, and whether or not there is a lag or an acceleration. Any concerns raised at this simple low-tech appointment can lead to further more intensive, high tech studies, such as ultrasound. At ultrasound we can not only see the various measurements of the baby but we can also see features of the placenta albeit more subtly. Finally, we can see the amniotic fluid. The amniotic fluid reveals a great deal about the pregnancy. Most of the time we check amniotic fluid, it is in the normal range. However, it is not uncommon to find abnormal levels of amniotic fluid, either high or low. High amniotic fluid is called polyhydramnios, whereas, low amniotic fluid is called oligohydramnios. Amniotic fluid is an early indicator of the well-being of the pregnancy and the baby. You might say it is our canary in the coal mine. Learn more HERE.
Whether a baby is large or small depends on two things : the innate qualities of the baby and the maternal enviroment in which he or she grows. The growth rate and specific size measurements of the baby tell us a great deal, which is why we are continuously tracking them by exam and by Ultrasound. Major deviations in any direction are a source for concern.
Click HERE to learn more.
I recently finished and published the website's pages on Infections in Pregnancy. At the bottom of those pages, I have added that much again in a new section called "Other infections of Perinatal Significance". Now this may sound way too scientific and unrelated to daily life, but nothing could be further from the truth. These are the big time everyday infections we hear of each week: Pertussis (whooping cough), Bacterial Vaginosis, Toxoplasmosis, Influenza, Herpes, Chicken Pox, and more. Learn more about these common infections and how they pose special risks to pregnant women. Learn what you can do to protect yourself and those around you.
And, also coming tomorrow, will be a special section on Preterm Labor. Learn the facts and figures as we know them, and how we handle Preterm Labor today. Hint: It is not how we handled it even 5 years ago.
Thanks for all your well wishes. I am making a good recovery.
We bring you back to your regularly scheduled programming (Old time radio announcer voice here) , "Gestational Diabetes".
My suspicion that we see more of this every year is substantiated. Gestational or pregnancy-related Diabetes (GDM) is on the rise. It seems to track right along with the obesity epidemic. However, it is a cloud with a very silver lining. In many cases, the women I see who receive a diagnosis of GDM see me as their primary doctor, and, like many others, come in regularly only when they are pregnant. As such, it is golden opportunity for effective lifestyle intervention.
GDM patients receive a whole package of nutritional, fitness and lifestyle advice, treatment and monitoring which I think, in the final analysis, will add years to their lives. They learn about the pleasure and ease of good nutrition, about personal organization, and about optimizing health. They do this through learning to craft meal and snack plans with the diabetic educator and my office. They learn to structure their days to a very high degree as a result of having to have blood sugar checks, medication and meals and snacks at just the right time. They are also introduced to mild regular exercise or at least physical therapy, which they uniformly enjoy. They report weekly for monitoring and feedback. Most of the time they achieve great results and feel good about themselves.
And here's the cherry on top: If patients keep up the nutrition and exercise after baby is born, their weight and body composition drift naturally toward the optimal. And that's worth its weight in gold.
Learn more HERE on our page about Gestational Diabetes Mellitus.
You've no doubt heard of or gotten a prenatal lab panel. The panel includes a number of tests for infections that might have an effect on mother or baby during the pregnancy.
For most common infectious diseases, like the flu, you know you have it almost right away. Others can be carried silently for years, and what we test includes them. If we know about them, we have a chance at treating them before they can cause harm to mom or baby. Learn more HERE.
Did you know pregnancy has an effect on the health of your mouth and teeth? Did you know good dental health has a measurable effect on your lifelong general health? The connection isn’t immediately obvious, but what goes on in your mouth relates intimately with your whole body. Check out our new page on Dental Health in Pregnancy to learn more.
When I was a little girl in the 1960s, pregnant women wore loose billowing clothes in futile efforts to hide their pregnancies. The round silhouette of the pregnant belly was considered too suggestive for public presentation. Pregnant women were encouraged to stay home out of sight and rest.
Fast forward to 2015 and not only are women wearing yoga pants in public, but pregnant women are too, complete with body conscious form fitting exercise tops in bright colors. They are out and about flying that pregnancy flag and getting fit. I love it. Do you exercise ? Would you continue your exercise in pregnancy? Review the facts on the subject here on my page on Exercise and Pregnancy.
Mother Nature considers pregnancy the height of her achievement. Because of this, she will throw all your bodily resources toward the cause. It's no wonder we feel like pregnancy takes over our bodies and, by full term, uses up most, if not all, of our strength. The rapid growth and development of not only the baby but of our own bodies is not without its dramatic and sometimes uncomfortable sensations. To learn more about these and how to deal with them. Click HERE.
Many things related to food change in pregnancy. What you need changes. What you like changes. Some of these changes have reasons. Some are just plain weird.
You need to know a few things about nutrition in pregnancy to deal with all of this and to make sure both you and baby are getting the best nutrition possible. Learn more HERE.
The Flathead Valley has a problem with narcotics. I am told this is not unique to our Valley. I never thought I would have this much first hand experience with narcotics, even heroin.
Problems with narcotics affect our women of childbearing age. Narcotic use in pregnancy is associated with low birth weight, preterm labor, SIDS and several major birth defects, as well as a lengthy neonatal withdrawal.
Narcotics are a class of drug which acts in our body though our body's own neurotransmitter and receptor system. We have many neurotransmitters, tiny molecular messengers that allow us to feel sensations and even emotions. Neurotransmitters like dopamine bind, lock and key style, to specific receptors in nerve cells and set off a reaction which make perception possible.
Narcotics also fit these nerve cell receptors. While bound at the receptor, narcotics can block pain and simulate pleasure. That is why they work, and that is why they are abused.
If only that were the whole story. You see, when a narcotic binds at the receptor, it stimulates an electrical potential, or pulse, down to the end of the nerve cell, and there another neurotransmitter is secreted, further conveying the signal. If there is constantly narcotic at the receptor, the molecules at the other end get depleted and the system no longer works.
The patient initially experiences relief with use of the narcotic. If too much is used for too long, it begins to no longer work. Worse still, more drug barely produces the feeling of being at baseline. No drug comes to feel worse than bad; hideous, in fact. More and more needs to be used to even feel baseline. This is the basis of addiction.
Patients, caregivers, and bad luck are responsible when things get out of hand. It is always easier to give or take a pill than to treat, cure, or work on things. Physical methods like exercises and therapy take time and are not always perfect. Surgery is expensive, and not always the answer to pain. Other nonnarcotic medications may be partial solutions.
Life can be hard and confusing. Well meaning people can slip unknowingly from using pain meds to treat real pain, to using them to treat other things like withdrawal, anxiety, or their ability to deal with life. Those of us who care about these people need to start from a place of knowledge and compassion. No one really signs up to be miserable.
