Labor Day 2.0

If I found myself unexpectedly on a trivia game show, I could probably have told you Labor Day was in some way a holiday to honor the struggles of those in the Labor movement in the late 1800s-early 1900s ish. I knew there had been strikes over working hours and conditions. And yet… I didn’t reallllllly know why we had this day where so many people were off work and stores offer awesome sales. I wanted to know how we, today, could best understand and honor this day. So I put on my nerd hat and started reading.

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Photo by Pixabay on Pexels.com

I stumbled across an article by Jay Zagorsky, “The Eclectic Economist”, titled Have we forgotten the true meaning of labor day? In it, he says, “Labor Day came about because workers felt they were spending too many hours and days on the job.” He describes the working conditions of those laborers – 70 hour work weeks, 7 days a week, few if any holidays.

wait…. is he talking about parenting?

He suggests, “If you work all the time and never really take a vacation, start a new ritual that honors the original spirit of Labor Day. Give yourself the day off.” … tell me more!

Now, I’m not saying hard labor in a late 19th century factory is the same as raising kids and maintaining a household amidst admittedly first world problems. And probably someone’s going to get on a high horse and ‘educate me’ on the insensitivity of this post.

On the other hand… 70 hour work week?? wow! sounds luxurious! If you are lucky and your kids reliably sleep 8 hours a night, you, as a parent are still left with 112 hours a week of duty. Repeatedly doing the same actions, in a single work environment, over and over and over… few if any bathroom or lunch breaks. You have to admit there are some major parallels up in here. Labor comes in lots of different forms these days. We are all more worn down, more disconnected, more at-the-end-of-our-frayed-and-breaking-ropes than ever.

I’m not saying we shouldn’t celebrate the work done by those early activists to fight for safer and more humane working conditions. Of course that should still be part of the day. But, can we not also update this holiday like we have for so many others?? How many of you still light a bonfire and sacrifice an animal on Samhain (Halloween)? Who’s asking the town bum to order around the wealthy people to celebrate Christmas (Thanks History Channel for that crazy info)? Holiday celebrations change as we do over time.

I propose a new kind of Labor Day celebration. Whatever your “Labor” is – do the opposite. Are you slaving your days away in an office away from your family? Stay home. Turn off your computer and phone and just be with them. Are you a stay-at-home parent, never getting a minute away to breathe? Get the grandparents over or hire a babysitter and go do something utterly selfish that feeds your soul.

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Photo by Artem Bali on Pexels.com

And then, make time to think like those early activists and plan how to make your laboring life more humane, more healthy, more supportive of a whole YOU. Write it down, then plan how you will make it happen – like a better version of New Year’s resolutions. Because you’ll keep this one, right?

Labor Day: Because you’re worth it

Happy Labor Day 2.0 people!

DSC_4458BWDr. Annie is a family physician, mom of 2 with 1 on the way, married to a busy doctor and dedicated to fending for her own non-laboring self-care time.

Pregnant, MD: First Trimester Woes

Whether you’re an experienced mama or a first-timer, there is always a bit of a rollercoaster that ensues between pregnancy test turning positive and the onset of pregnancy related symptoms. Every single person has a different experience, but lucky for me as a doctor, I’ve had the majority of “usual pregnancy symptoms” happen to me in one of my 3 pregnancies – giving me insider knowledge that I appreciate as it can help me help others… even if I curse them in the moment.

I’ll give a little run-down of the most common things, how to deal and when to worry here. More in depth posts will follow! And, as always, this is not personalized medical care here – ask your own health care provider for help on any issues.

Nausea

There are women out there – I know because I’ve seen them in my clinic – who do not experience pregnancy-related nausea. If this is you, move on, you magical unicorn being, you. For the rest of us the nausea, oversensitivity to smells, food aversions and cravings and sometimes vomiting usually hits between 6-8 weeks of pregnancy and lasts until 14-16 weeks… or until birth for some of the really special ones of us.

Some simple tips can help minimize how bad it is, but by far, the most important thing, is to STAY AHEAD OF IT! The nausea feeds off itself. Do NOT try to tough this one out – the worse it gets, the worse it will get. Oh, ps. even though you’re not eating real meals, you may start to look like you just had a Thanksgiving feast thanks to the bloating – hooray!

  1. Eat all. the. time. Seriously, you should put some little bit of caloric intake in your mouth every 1-2 hours while awake. Avoid big meals – split them up into basically constant grazing throughout the day. The empty stomach is your enemy.
  2. Start keeping easy-to-access snacks everywhere – baggies of whole-grain crackers, applesauce pouches, dried fruit, cheese sticks and nuts make healthy options, but really this is the time to least worry about nutrition. If you are getting bad morning sickness, try to eat a snack in the middle of the night or have one on your bedside table for before you get out of bed. This is your most important and first line of defense, take it seriously!!
  3. Try the different natural aids. Some people do well with ginger, others with citrus, others with mints. I’m a big fan of Preggy Pop Drops as an emergency purse go-to. Others swear by Sea Band Mama acupressure bands. See what works for you.
  4.  Avoid places you know you’ll be assaulted by strong smells. If they are unavoidable, consider an aromatherapy necklace or a scarf spritzed with a light fragrance for defense.
  5. Do not, and I mean DO NOT try to force yourself to eat something you know doesn’t sound good out of politeness. You will regret it. I don’t care if grandma slaved away on the chicken piccata for hours. Not worth seeing it again later in reverse. You can always go with “my doctor said I can’t eat that” ;^)
  6. Distract yourself. Dwelling on the sensation of nausea will get you one thing: more nausea. This is the time to give yourself some grace about catching up on Netflix, flipping through magazines or scrolling social media during the difficult moments. The more you can keep your mind off the sensation, the less severe it will get.
  7. Take your prenatal vitamin at NIGHT, not in the morning.

When to worry: If you are vomiting multiple times per day or unable to keep nourished or hydrated, contact your doctor right away. You may need to start on Diclegis (doxylamine and vitamin B6) to help prevent nausea or need a prescription anti-nausea medicine to take.

Boobs

I will never forget reading The Girlfriends’ Guide to Pregnancy when I was gestating for the first time and bursting into hysterical laughter as she describes the “titty fairy” coming to visit. One of the first signs of pregnancy many women experience is a rapid, and often very painful expansion of one or multiple cup sizes in your breasts.

The first time for me, I felt like someone had taken a baseball bat to my poor unsuspecting boobies. Going up stairs brought me to tears with the bouncing. This is (unfortunately) totally normal. It also will get better towards the end of the first trimester for most.

When to worry: The only danger present here is the unwanted attention the newly enlarged chest apparatus might garner from your partner – warn them ahead of time so they don’t unintentionally grab and get karate kicked in self-defense!!

Discharge

Yep, the vaginal kind. You’ll get more of it. It might smell different. This is normal. Not a whole lot else to say about that.

When to worry: A slight amount of pink or brown spotting can be normal in pregnancy, but if you have more bleeding or ongoing spotting or if it comes with any cramping or other new symptoms, you should talk to your health care provider. You should also be checked if you have vaginal pain or discomfort or the vaginal discharge is yellow, green or foul-smelling.

Dreams and Feelings

You are probably going to get some CRAZAY dreams, girlfriend. Some lucky ladies have dreams that include “dream-gasms”, orgasms in your sleep, thanks to the increased blood flow to the lady parts. Some less lucky ladies have very disturbing and vivid dreams.

It has become cliche to talk about the pregnancy hormone emotional rollercoaster, but it’s actually a thing. Many women can be laughing at a joke one moment and balling hysterically at a toilet paper commercial the next. Ups and downs just get a little more extreme thanks to ye olde brain chemistry. Again – give yourself a break here – and also maybe warn those around you.

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When to worry: If your dreams are causing you distress in the daytime, it may help to see a counselor. If you are experiencing consistent anxiety or depressed mood that is impacting your day to day function, talk to your health care provider.

Fatigue

This one hit me hard with this pregnancy. I don’t know if I just had mom-nesia (when you forget how bad pregnancy was after a while because you’re momming), or if it wasn’t this bad the last couple times. I could barely drag myself off the couch for about 2 months straight. This is mainly because of the hormone shift that goes on and your body trying to make 1/3 more blood than it usually keeps on hand in preparation for the rest of pregnancy and birth. You’re functioning like you’re very anemic. You might feel short of breath with relatively little physical activity. You might micro-sleep while at dinner with boring relatives. It’s normal to be tired AF.

Listen to that voice – you NEED rest. Follow the medical school mantra: Don’t stand if you can sit, don’t sit if you can lie down and don’t be awake if you can sleep.

When to worry: If you have family history of thyroid problems, a known history of anemia yourself or might be low on vitamin D (if you aren’t taking a supplement and don’t spend all day in the sun), you might need extra blood tests to make sure your level of fatigue is normal. Ask your person.

Potty Problems

You’re gonna pee a LOT. I went 9 times in 1 night. My husband thinks this is the worst thing about pregnancy because apparently I grunt like a grizzly bear trying to get out of bed at night and wake him up. Guess how sorry I feel for him?

Don’t let this stop you from staying hydrated!! Think of it as a great way to get in your steps, because you’re probably not feeling like doing much other exercise right now.

Bowel movements, on the other hand, tend to have the opposite change. Constipation is a super common pregnancy woe. The gut moves slower (part of the issue with above-mentioned nausea, ahem). Try as much as you can to get in fiber. Prune, pear, peach and plum fruit or juice can also help as do probiotics for many. Simethicone (gas-x) can help with gassiness and is safe. If that’s not getting you a daily or close-to-daily BM, talk to your health care provider about other safe options.

When to worry: If you have pain when you go pee, a history of diabetes in the family or fevers or back pain, you should be checked by your health care provider. If the constipation is several days ongoing or causing significant abdominal discomfort – also check in with them.

Other

So many other things can come up – again, every pregnancy is different. There is a whole cornucopia of options for how to be miserable in the first trimester – yeeha!!

Your skin might get sensitive, decide to rehash teenage acne or have color changes and sprout new moles. You might have strange metallic taste in your mouth all the time. You might have headaches. You might get crazy I-ate-the-habanero-salsa-by-accident level heartburn and reflux. Or maybe, just maybe, you’ll be the unicorn that skates through with nary a complaint. Hats off to you, miracle mama!

Bottom line – ask your health care provider about anything odd for you. We LOVE talking about this stuff – these are the easy questions for us and make us feel smart. Don’t hesitate to bring something up at your visit or between. And remember – this too shall pass.

Dr. Annie is a married mom of 2 with one more on the way and family doctor in the Sacramento area.

Dr. Annie Answers: Water Safety

TRIGGER ALERT, Child loss and drowning discussed in this post. It’s not fun to read about but it might, just might, save your kid’s life.

Yesterday, we got to enjoy a rare hot and sunny Washington day on our friend’s ski boat. After the husbands took turns reliving their glory days on wakeboard and mono-ski, we put out the “Sidewinder” tube and my good friend went out for a much more tame go with her son and our two girls.

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Everyone was safely ensconced in life jackets. My husband, ER doctor and former lifeguard, was perched on the back of the boat ready to leap in if anyone was jostled off. Both girls know how to swim without floaties. We never went over 15 mph. And still, with every bump, every turn over the wake, my heart was in my throat imagining one of them popping off into the water and drowning.

As a doctor, I know that drowning is the leading killer of children aged 1-4. If there is only time for 1 thing to talk about at the end of a well-child visit, that’s the one I target. It’s something most parents worry about whether they know the statistics or not. And yet – we still miss the biggest risk most of the time.

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Kids are not at high risk of drowning when we are all playing together in the pool. They’re not at high risk even when bouncing along in a life jacket behind a boat. It’s when we don’t think they’re going in the water at all that the danger is highest.

The day before our boating, I had lounged and gabbed with our friends on the beach – Rosie and Mimi 200 yards down the empty shore collecting seashells and I was honestly more worried that the bald eagle we kept spotting would come carry one of them away than the very real danger they could wander down to the water’s edge without us noticing and drown in moments. We ALL forget that it’s these unguarded moments that are the real danger. Even the professionals. 

The recent stories of toddlers drowning in the media – including the tragic loss of Bode Miller’s daughter and Nicole Hugh’s son – have started a new fight to promote water safety with the AAP and in the public eye. They highlight just how quickly the lives of even the best parents can be changed by drowning. And also, that you can do things to decrease the risk and improve chances of survival.

So, what can you do? Should we all keep life vests on our kids 24/7 when we are in walking distance of water? Should we just give up and never let them around water deeper than an inch? Leashes? Well…. I mean you could. But, there are more practical solutions.

1) Education

Talk to your kids about water safety from the beginning. I have erred on the side of scaring them about it because I’d rather they be a little timid as swimmers than over-confident.

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Strongly consider enrolling them in ISR Self Rescue classes sometime after age 6 months and before 6 years old. These classes teach infants to toddlers how to roll over and float safely if they fall into water.

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Photo credit: Brendan Nicholson

I think my friend, the super smart mama Dr. Elizabeth Nicholson (that’s her cutie above), says it best:

I’ve seen conflicting opinions of ISR over the years … As an Emergency Medicine physician, I am painfully aware of drowning risks. Each summer, I console at least one family after the loss of their child. Primary prevention, such as locked fences and sturdy pool covers are the most important, but we all know that even the most attentive caretakers have escape artists for children. It takes only seconds.

I wanted to have extra seconds to find my kids. I viewed drowning prevention through ISR like buckling a car seat or holding my hand in a busy parking lot. It might not have been fun every minute, but crucially important.

Our instructor is wonderful. She pushes the kids in a safe a supported manner. They are reassured during class and proud after learning new skills. Even with vastly different temperaments, both of my kids have learned the skills AND love the water. See for yourself!

 

 

Want to see it in action? Check out the video of the “final lesson”, falling in with clothes on below:

Look up the closest certified program to you here.

2) Tools

  1. Barriers: If you own a pool, a pool fence or safety-focused pool cover is a MUST. We moved into the gorgeous backyard oasis above, but all I saw was drowning risk until we got our All-Safe Pool Fence. If you’re inside and not in “swim mode”, keep the kids behind locked doors – make sure the locks are child-proof. A hook lock at home or simple stick-on child lock at a vacation rental can be applied to most sliders above child’s reach to be safe.
  2. Lifeguards: If you’re at someone else’s home or on a watery fun vacation without a fence, treat watching the kids like lifeguards do. Someone should always be the primary observer. If that person needs to go, they need to actively and explicitly hand off duty to another adult. When you’re in a group setting without this designation, it is WAY too easy for everyone to assume someone else is watching the kids – which is what happened to this family
  3. Life jackets: If the kids are just playing in the yard around an open pool or on the beach near the waves, they still need life jackets on and/or an adult “lifeguard”. 20045346_10100140255349096_1854036280355769801_o.jpg
  4. Pool alarms: Again, if this is your home or somewhere you go frequently, a good back-up measure is an alarm so you know it they’re in the vicinity.

3) Rescue

If you haven’t already, enroll yourself and your adult family members in a CPR class. Make sure to continue updating it when it expires. Drowning happens quickly and silently and you can’t be sure how long the kid has been in the water. If you get to them quickly, rapid initiation of CPR while someone else calls 911 can absolutely save their lives.

Adult & Child CPR Anytime Kit

You can look up classes in your area here or get at home kits. Don’t let this be one of those, “well I was meaning to do it, but we were just so busy….” items. Look it up today. Put it on the calendar for within the next month. Chances are you might literally save a life.

4) Spread the word

Tell. Your. Friends. If you see unsafe practices around water – say something. We can’t know how many lives have been saved by the preventive measures above, but it’s definitely significant. Not sure where to start? Send them this blog article or post a pic on social media saying “PSA: pool fences save lives” or whatever speaks to you. Just keep people talking about it. We should be talking about this AT LEAST as much as preventing SIDS or the proper carseat positioning in your vehicle or which screen time is the least evil screen time because it still remains the leading cause of early childhood death.

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Alternatively… stick to inland splash pads.

Dr. Annie is a married mom of 2 plus 1 on the way and family physician in the Sacramento area.

Dr. Annie Answers: Announcing A Pregnancy

About half of my initial prenatal visits with first time parents, the question comes up, “When is the best/safest/ideal time to announce we are expecting?”. People worry about announcing and then having something happen – a miscarriage or abnormal test result – and then having to explain to everyone on top of dealing with that news.

It’s a question that has no “right” answer. Lately, it’s been debated even more on social media with celebrities from Beyonce to Lindsay Lohan to Bethenny Frankel opening up about miscarriage in the hopes that their experience can help other moms in a hard moment. It can be stressful to not only deal with the issues of first trimester (that fatigue is something ELSE! plus… morning sickness, ughhhhhh) but also try to come up with a super cute announcement and try to decide who to tell when.

The bottom line advice I give people is: Tell the people who you would want to support you if something bad did happen early. Tell the rest of the world later – probably after 12 weeks or so or when you get your genetic screening tests back and risk of miscarriage decreases significantly.  This is also a good time to tell your work and start planning for maternity leave. You might also have trouble “hiding” your belly soon after this – and it’s way more comfortable to just rock those maternity clothes!

However, if you feel strongly that you want to be part of the movement to normalize early pregnancy loss, and show your true pregnancy journey from the beginning – go for it, girl! Miscarriage happens to 1 in 5 conceptions and it is wonderful that there’s so much more support and information out there today to help women (and their partners) through the event.

Now, on to the pregnancy announcement…. How stressful is living in this pinterest-perfect world when you just want to tell people you’re preggers??

Do you get a custom-made onesie and take perfectly edited photo?

Order custom bottles of Rose for everyone else when you can’t drink (this one seems cruel and unusual punishment to me….)?

Set up adorable pet photo shoot?

My personal fave, the realist announcement.

The options are endless. And potentially stressful. We did cutesy announcements with pregnancy 1 and 2, but I always felt they were lacking, comparing myself to those perfect photos online.

I started thinking about how I would announce a third pregnancy before my IUD was even out (which was done safely in a clinic, btw… in case you were wondering after Adventures of a Doctor Mommy). Would we do a funny, “Officially outnumbered” one? A pretty family photo with the girls kissing my round belly? A limerick? An ultrasound photo? An adorable trio of succulents? The options are overwhelming!

So, by the way, that picture up there of the pregnancy test and ultrasound? That’s not a stock photo. That’s mine. Baby Ray #3 on the way! Due December 31st. Surprise! Did you think this was just a regular Dr. Annie post? 😋😆😂 cracking myself up over here.

It turns out, when I’m working, have 2 kids already, am dealing with nausea all day, am so tired I actually fall asleep sitting up, am running a side business and trying to organize a blog, I just don’t have time for a fancy announcement! I honestly don’t think the 4 of us have all been dressed and groomed in any decent way, at the same time, since that second pink line showed up.

Photo cred: 5 yo Rosie, the only way I get good pics these days

And I realized… that’s part of why I felt so excited to have this third baby. The dynamic changes and my inner Type A perfectionist just gets overruled by me wanting to enjoy as many of the moments of non-vomiting as I can with my family. Maybe we will get it together to do a cute gender reveal….. maybe not. I have not taken any pictures of it, but I have sat back and enjoyed Rosie singing songs to my already growing belly (third baby does not mess around with bumping out!). I have snuggled my soon-to-be middle child a whole lot more, reveling in this last bit of time with her as my baby. And that, to me, is the most beautiful gift of all.

So, mama’s and families out there reading this? Listen to yourself. You know when the time is right for you. You know what the right announcement is for you. Feel inspired to go fancy? Do it up! Can’t get around to it? Just say it simply. One of the most important lessons of parenthood is learning to listen to that inner voice. Make sure you follow us for lots more pregnancy-related posts as well as our other usual variety of spectacular content to come!

xoxo, Dr. Preggers.

18_SMG_Ray_Anne_MD_FamilyMed-5654_print  Dr. Annie is a wife, mom of 2 little girls with 1 more on the way and family doctor in the Sacramento area.

Dr. Annie Answers: A Parent’s Intuition

Many of the things that people have said they appreciate about me as a doctor are the direct result of advice from one of my best mentors. One thing – trusting a parent’s intuition – has literally saved the lives of multiple patients of mine, and now hopefully, also that of my nephew. He’s in the womb below, while I was also preggers with baby #2.

As a resident, I remember feeling so lost in the beginning about offering advice on things like breastfeeding or colicky babies or a kid with a weird rash. I had been around lots of kids, sure, but I had never been pregnant, had never tried to breastfed a baby, or to get a fussy toddler to take medicine.

I, for sure, gave some asinine advice in those early days and more than once had patients laugh in my face (sorry pregnant patient who I tried to tell to work on her core strength for third trimester back pain!!). What Dr. Pippitt told me was, “Of course you don’t know their kid better than they do, but you do know medicine better than most of them.” Her advice now seems so obvious – let parents be the experts on their own kids. This applies to people being the expert on their own bodies also, but I’ve found we misinterpret ourselves more than parents do their kids…. so paying attention to what parents think is even more important IMHO.

Since then, I, of course, have become a mom twice over. I know tons more practical advice and can be quite a bit more helpful in treatment strategies. But! I still know that every parent is the expert on their own kid. My bottom line advice for when to have something checked out, followed up on, checked out again is always “if you, as the parent, are still worried or feel something’s not right”.

The validity of this was recently driven home in a tragic way. My sister, back in March, called me on FaceTime to show me a lump on her 3 year old kid’s neck. I took one look at it and thought, “that’s not normal”. My sister and her wife agreed and took him in to their pediatrician right away. The doc told them it was nothing to worry about. But… they were still worried when it didn’t go away. They saw ENT who also said it was nothing. But… they were still worried. Finally at 2 month follow up, it was bigger, not smaller. A few weeks later an MRI and biopsy had confirmed it was Hodgkin Lymphoma, an extremely rare, but very treatable diagnosis in someone his age.

Their intuition was right on, and had they not followed up despite being told it was nothing, it could have been caught at a later and more dangerous stage.

So, the next time you find yourself with that, “something’s not right” feeling, go ahead and get checked. This goes for your own body too, of course. Make sure the provider you see is able to make you feel confident that your fear can be ruled out before you go. This doesn’t mean they will do every test imaginable every time – sometimes we can take a look at something and tell you with high level of certainty, “you don’t need to worry”. We did go to school for a long time to learn that medical side of things, after all. But, if your care provider doesn’t listen to or respect your knowledge about your own kid or your own body, find a new one.

Dr. Annie is a married mother of 2, aunt of dozens of other amazing kids and family doctor in the Sacramento Area.

Ps. If you want to support my sister & her family, you can find them on Caringbridge.com under starlinglynnalesker

Dr. Annie Answers: Getting Pregnant

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It’s kinda crazy to me that a lot of us spend so much of our lives worrying about NOT getting pregnant and then you go straight from that to worrying about getting pregnant. This, like many issues addressed here, can be influenced by many personal health issues. Talk about it with YOUR doctor. I’m just here to give some basic info. This advice also is less applicable if you’re using a sperm donor or other fertility treatments for any reason, but some of it still applies.

So you think you want to get pregnant…

Number 1: Start a prenatal vitamin. *Ideally* you’re already taking one if you are of childbearing age (aka teens through 40s). If not, start NOW. You should be on a prenatal vitamin at least 3 months, and ideally 1 year before you conceive. What if you’re already trying to conceive? Start now. Better today than next week. Just, the sooner the better.

Which prenatal vitamin is right for me? There are lots of brands, gummy options, drinkable options, etc… to choose from. Find one that you can tolerate taking. The basics it needs to have are 400-1000mcg of folate, 27mg iron, 1000 units vitamin D, and 100mcg iodine. If your diet does not have a lot of healthy omega oils, also get a 1000mg daily DHA/EPA supplement. I personally use Honest company prenatal and DHA.

Talk to your health care provider about any medications you’re taking and if they are safe while trying to conceive. Make sure any chronic health issues such as thyroid problems, diabetes, or high blood pressure have been checked and are in good control. Plan ahead for these!

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This depends a little on what you were using. You CAN get pregnant the month (or week) you stop any form of birth control. So don’t stop using anything unless you are A-OK with being pregnant right away. That being said, hormonal birth control is more likely to have a “wash-out” period where you don’t ovulate regularly and are less likely to conceive. DepoProvera, oral pills (especially if you’re skipping periods), the patch, the nuva-ring and Nexplanon/Implanon all have a 3-6 month expected wash-out. I have seen it take up to a year with Depo. IUDs are less likely to have wash-out, but we wouldn’t be surprised if it took 3 months or so.

So, let’s say you want to get pregnant “sometime in 2019”. Easy. Go off birth control after you have that New Year’s blow-out party. What if you have a more specific window? You can plan to go off birth control 3-6 months in advance of that window, but use condoms to prevent pregnancy until then. Know that condoms are only 85% effective at best and you could still get pregnant earlier than you think. So, if, for example it would be devastating to get pregnant in February (calculate due date from theoretical conception date out here), don’t stop birth control until after that.

How to get pregnant….

SO, um, there are of course some basics here I’m assuming everyone knows about human reproduction. If you’re confused on the what goes where, may I refer you back to wikipedia under “birds and bees”. If you’re not in a relationship where sperm is readily available or you can’t have intercourse for any reason – see a fertility specialist about how to get that all going.

If those exceptions above don’t apply to you… the most reliable way to get pregnant is also the simplest. Have unprotected intercourse every other day from right after your bleeding stops until you start bleeding again. Every. Other. Day. Not every 3 days. Not twice a day (but good for you if this is your issue!). This gives you optimal semen volume and you will never miss your fertile window because it lasts 2-4 days. Boom.

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Now we get to the people who are absolutely opposed to having sex every other day. For some couples, that’s not sustainable over the several months it can take to get pregnant. That’s totally fine! If that’s the case, I usually recommend the Glow Ovulation, Period Tracker App. This lets you track cervical mucus, basal body temperature, ovulation sticks and pregnancy tests, sexy time and everything else about your cycle. Take at least 1 month to track everything while still using condoms so you get some understanding of your cycle.

Then, go for that fertile window! Again, sex every other day or daily. What kind of sex? Pretty much whatever. Position doesn’t matter. Ideally, the person trying to conceive should have an orgasm during or after (though there isn’t evidence that this is necessary, it has little down side!). And if you’re gonna use lube, use this lubricant. Chill out for 5-10 minutes after sperm gets in there then go about your business.

Did you say cervical mucus? Sounds so gross, but is actually the easiest way to check if you are fertile. Just look at the TP after you wipe when you go pee. When you’re approaching fertility and fertile, you’ll notice a clear discharge like egg white. When this is super gooey/stretchy – that’s peak fertility. More nitty gritty here.

How long is this going to take?

If you’re under age 35 it is normal to take up to 1 year to get pregnant depending on your health and the health of your partner. Most couples will get pregnant within 3-6 months. If you’re over 35, the timing gets a little more pressured because fertility starts to decline significantly around age 37. In this case, we would usually only give you 6 months before further testing. If you’ve already been trying to conceive for that long – go see your doc.

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Photo cred: FionaMargoPhotography.com

Final note: Don’t sabotage your efforts.

If you’re in the exciting phase of ‘trying to conceive’, don’t do things that are going to stress you out and make it harder or threaten an early pregnancy. Ask your health care provider if any medications you’re taking are safe. Don’t go binge drinking. Don’t smoke marijuana. Don’t smoke anything for that matter. Have your sperm provider avoid hot-tubs, tight underwear and long bike rides. Eat lots of healthy fruits and vegetables and proteins and fats (first trimester is ROUGH ya’ll, you will need those nutrients stocked up). Exercise regularly. Avoid over the counter medicines other than tylenol and tums without asking your healthcare provider. And… enjoy the ride!

ps. Make sure you follow us for an update on my own adventure trying to conceive baby #3 coming soon 😀

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Dr. Annie is a family physician and married mom of 2 in the Sacramento Area.

Dr. Annie Answers: Open Letter to my Patients

Dear patients,

There are things you say to me on a daily basis that I wish I could make nationwide public service announcements about in the midst of prime-time TV. We are early in our blog-adventure, but I’m just gonna put these out there in the hopes that someday they’ll be shared widely (as a close second option to a televised career).

Things you don’t need to apologize for

In my opinion, women apologize out of habit for WAY too much sh&* anyway (I’m guilty too), and I get a fair amount of apologies from men too, but these? Let them leave your mind.

  1. Women of the world, I could not care less if your legs are shaved. Not a bit. Not at all. Nor do other doctors. Unless you’re seeing a gynecologist, the rest of us also see men – know what? Men NEVER say, “sorry, I didn’t shave my [insert any body part, ever]”, when they come in to get checked out. You have enough to worry about and apologize for – let this one go.
  2. Same goes for your choice of pubic hair management. There’s a whole large part of the population that wouldn’t ever consider waxing/shaving/electrolysis and you know what? We feel fine about caring for them too.
  3. While we’re here – no apologizing for menstruating!! We have seen blood before. Menstrual blood. Body blood. Birthing blood. All the bloods. It doesn’t phase us a bit – or else we would have chosen another profession.
  4. If you cry in the office, it’s because you need help and you do NOT need to apologize for those tears, ever. If you cry, it’s because you felt comfortable enough with me as a provider that you could open up about what is REALLY bothering you – whether physical, mental or emotional. That is one of the greatest gifts to a primary care provider. That is our goal. No apologies for that.
  5. Having ear wax. We all do. We can clean it out. Don’t use q-tips to clean it, they only make it worse. (But if you do have to use a q-tip, always lubricate it with olive oil or vaseline!)

 

Exercise and diet

I’m gonna post in detail about this later. The bottom line here is: you can get an excellent workout in 12 minutes with high intensity interval training. And almost no one should ever be on a low-fat diet*. The low-fat diet trend was WRONG. It is BAD for you. Fat does not lead to high cholesterol or heart disease if it’s the right kind of fat. Know what does? Sugar. What’s worse for you: Bacon or Skittles?? I bet some people would guess the Bacon. Wrong.

A picture is worth 1000 words

If you have a rash that comes and goes – take a picture! If your kid is walking funny but only sometimes – video it! Take notes of what’s going on and bring them. Your recollections and descriptions may or may not be useful, but those are.

Agenda-setting

A list of all your questions is so helpful for organizing what to get to. However, you should know that depending on where your provider works, they may have NO choice in how long your appointment is. Many institutions do not allow us longer than 15 or 20 minutes total – that includes the 5 minutes it takes you to check in and have vital signs done. So, while we for sure want to fix everything (trust me, that’s why we picked this job!), we just don’t have time. We may have to choose some things for now and some for later. Insurance also regulates now what can be done at a “Physical” or “Wellness visit” and most will not let us address ‘problems’, ONLY ‘preventive care’ at those appointments. It is not our choice. We can’t “change the coding”, or we could lose our licenses. Talk to your lawmakers about this!!!

Share, learn, love.

-Dr. Annie

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