Structure Sunday: Labor and Vaginal Delivery

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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. 

Food Friday : Breastfeeding

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There are all kinds of peculiar myths about breastfeeding. You may have heard that it is difficult and painful. You may feel too bashful to do it. But I would like to encourage everyone to give it strong, evidence based consideration, because I think it is one of the most gratifying aspects of having a young baby. It does take a little learning, and a little getting used to, but it is more than worth effort. Most first timers take about 7-10 days to get used to it and then they have it down. It is best for babies nutrition, immunity, brain development, teeth, etc etc. For mom, it helps with minimizing post partum blood loss. It hastens return to pre pregnancy weight. Finally, it is convenient and cost effective.

Click HERE for a introduction to what you will want to know. 

Wellness Wednesday: Induction of Labor

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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. 

 

Medical Monday: Preeclampsia and blood pressure issues in pregnancy

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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 .

Structure Sunday : Abnormalities of Amniotic Fluid

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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. 

Food Friday: Feeding the growing baby: growth restriction and growth acceleration

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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. 

Wellness Wednesday: Knowledge is Power. Get some.

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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. 

Back on Track Tuesday: Gestational Diabetes Mellitus

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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. 

 

Medical Monday: being a patient

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Yes folks that's my arm. There's nothing better for a doctor than to be a patient sometimes. Your regularly scheduled blog post is thus interrupted with this post about my small experience of being a little too sick. 

You may wonder how I came to be such a health nut. Well it's because I have lupus. I have to be extra careful and on top of things to stay healthy. The majority of the time I do very well, but once in a while a simple upper respiratory infection gets the better of me. I had to come in briefly for some extra medication and  I am feeling much better. I will probably not be in clinic for the next couple days. 

I was reminded of how vulnerable and wretched you feel when you are truly sick. I was reminded how much it means when people help you out. I had a good friend or two cover for me on labor and delivery, my husband who brought me in, and all the hot shots in the emergency room to tune me up. 

There are two messages as far as I can see. Number one, if you are not doing well reach out and get some help. Number two, if you see someone else not doing well check in with them. It means so much.

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Structure Sunday: STI testing in Prenatal Labs

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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. 

 

Wellness Wednesday: Exercise in Pregnancy

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 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. 

Medical Monday: Discomforts of Pregnancy

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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.

Structure Sunday: The Structure of Prenatal Care

How closely related is prenatal care to outcomes for mom and baby? Has prenatal care become available to everyone in the world? Does everyone in the United States get prenatal care? What does prenatal consist of anyway? Find out more HERE, in these fresh pages on our website. Expect these pages to be expanded sometime in the next couple days. And, have a joyous Passover and Happy Easter! 

Food (sort of) Friday: Prenatal Vitamins

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Prenatal Vitamins are a standard part of prenatal care. But did you know they should be started at least three months before pregnancy ? And did you know that 50 % of all pregnancies are unplanned ? Given these two facts you could make an argument for all women of childbearing age to take prenatal vitamins all of the time. 

What makes prenatal vitamins so special ?

Mayo Clinic recommends that a prenatal vitamin include at least the following : 

  • Folic acid — 400 to 800 micrograms
  • Calcium — 250 milligrams
  • Iron — 30 milligrams
  • Vitamin C — 50 milligrams
  • Zinc — 15 milligrams
  • Copper — 2 milligrams
  • Vitamin B-6 — 2 milligrams
  • Vitamin D — 400 international units

Consider folic acid. This is given to prevent defects of the baby's brain and spinal cord, what we call neural tube defects. These defects form in the first 28 days after conception, so often times the woman does not even know she's pregnant. This is why it is ideal for women to be on them in the three months before pregnancy. As soon as a woman decides to try to become pregnant she should start a prenatal vitamin. 

Prenatal Vitamins are not always easy to take. I recommend taking a gummy prenatal vitamins  if nausea is a problem. I also recommend taking them with food in the evening. Sometimes they cause constipation. Of course that is best dealt with by fluids, fiber, fruit and vegetables, but stool softeners can be used .

Pregnant women need more of just about every nutrient. This also includes calcium and iron, in addition to folic acid. Calcium is necessary for building bone. Iron is necessary for manufacturing red blood cells which carry oxygen to mom and baby. A deficiency of iron results in anemia, which is suboptimal for both mom and baby. Personally, I think Calcium taken separately from the Prenatal vitamin or iron causes them both to absorb better. It is also good to note that Calcium citrate is the most easily absorbed type of Calcium. Additionally, calcium should be paired with vitamin D. Most over the counter calcium supplements do just this. 

Newer data also indicate that it is beneficial for pregnant women to ensure that they are consuming at least 200 milligrams of DHA (docosahexaenoic acid) in addition to their prenatal vitamins. This seems to be beneficial for the development of unborn baby's brain. It is available by supplement or incorporated into a prescription prenatal vitamin. 

But vitamins are not the whole story. I have prepared a page devoted entirely to preparation for a planned pregnancy. You might be surprised to see some of the things that it contains. Have a look HERE.

Wellness Wednesday: Out of the (water) closet

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Trouble with incontinence can cause problems with body image, self esteem and confidence. It can also interfere with a woman's social life and her ability to stay fit. Incontinence is common, and should not be a source of shame. It should come out of the closet and be subject to evaluation and treatment. 

Learn more on the newly completed page about Urinary Incontinence. 

Please note that the entire section of Gynecology is now done ! 

Medical Monday: Pelvic Floor Relaxation and Prolapse

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Baby shower cake: champagne cake with raspberry filling, courtesy of MISS PATTY CAKES of Kalispell, Montana 

Baby shower cake: champagne cake with raspberry filling, courtesy of MISS PATTY CAKES of Kalispell, Montana 

Here's a problem that besets 1/3 to 1/4 of all US women, and that is rarely discussed. The risk factors are common and it greatly affects quality of life. This blog post will lead you to a newly completed page on this very important topic.

To learn more on this fascinating and important condition that affects so many, click HERE. 

And just so you know, this post is serving both as your Structure Sunday and Medical Monday posts for two reasons:

1. It required quite a bit of time and research

 2. On Saturday I threw a baby shower for our daughter Echo, who will have our first grandchild in May : ) 

Many thanks for your patience, 

 

Dr. Gina 

Food Friday : Party Food

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Despite my intense interest in nutrition, I believe the highest and best use of food is to forge bonds between people. Food is a natural centerpiece for social gatherings. It puts people at ease, and makes them feel good. It can, if presented correctly, cause us to slow down and connect with one another. 

I am blessed with a large extended family and group of friends. It has become our tradition to have frequent large gatherings which I think people really appreciate. Here are ten tips about parties and party food which I have learned along the way. 

 

  1. Entertain for traditional and nontraditional occasions. It's great to observe birthdays and holidays, but it is also fun to celebrate different things like graduations, the spring equinox, or the Academy Awards. Do not limit yourself to dinners. Brunch and lunch can be fun too, though a great deal of preparation has to be done the night before. 
  2. Partial pot luck is a very successful format. Partial pot luck is, as far as the guests are concerned, pot luck. They are each assigned a dish of your choice and mutual agreement, since you have made sure the menu is balanced. Behind the scenes, you make sure you have a flexible main dish, enough for almost everybody, and good beverages. You may also have your signature dish, which in my case is large fruit platter. That way you have the backbone of the meal covered, in case of no shows and dishes turning out poorly. 
  3. Be aware of any special dietary needs or preferences of your guests. I know it is extra work, but if you want to host you are obliged to have something for everyone. This includes vegans, vegetarians, diabetics, the pregnant and those nursing, the gluten intolerant, and those who do not eat pork or shellfish. 
  4. Set a beautiful table. Be creative. Check Pinterest. 
  5. Serve the meal in stages and take your time.  After you take a guest's coat and introduce them, offer them something to drink. We offer things like Perrier, Pellegrino, and club soda. With a sit down meal you can control how fast the courses come out. With a buffet you can do the same the as the dishes go onto and off the buffet table. 
  6. Its a party! Have several courses. Consider appetizers, a fancy salad (with multiple dressings on the side) , main dish, side dish, always a fruit platter with cheese, and at least one dessert. It is fair to have both cake and pie. I usually omit bread, rolls, rice and potatoes. Why ? Because dessert. 
  7. Consider a culinary theme like Mexican, Japanese, Italian, you name it. Rehearse your recipes ahead of time if need be. Do not perform culinary experiments on your guests.  
  8. Go ahead and have a rich fancy dessert. However, be sure to have something savory to go with it, such as cheese. Many people feel poorly with they have a big serving of sweets without anything to buffer it. Always offer coffee and tea afterwards. Be sure to have attractive decaf coffee and tea options. 
  9. Have enough predesignated helpers before, during and afterwards. Make sure no one person is burdened with cleanup. Even a pair of buddies in the kitchen washing dishes can be fun. 
  10. Be confident and know that it does not have to be perfect. Send invitations at least two weeks in advance, and plan the details of the event at least one week in advance and you will be fine !