Life & Littles Podcast!

Exciting news!!!

Our own Dr. Annie is on this week’s episode of Doctor Mommy, MD’s podcast talking about second trimester of pregnancy. The Life & Littles podcast may just be your new favorite listen, friends!

Photo credit Fiona Margo Photography

“Imagine your best friend is a doctor and a mom, what questions would you want to ask her over a glass of wine? What questions would you text her in the middle of the night?” Sound helpful?

Grab a coffee or glass of wine and tune in on iTunes and subscribe to get all the upcoming fun times!

https://itunes.apple.com/us/podcast/life-littles-with-doctor-mommy-md/id1451847392?mt=2&i=1000429939961

You can also find Shelly on Instagram and Facebook @doctormommymd and should check out her gorgeous blog while you’re at it!

Xoxo!

Pregnant MD: Third Trimester Woes

As always, this post is meant as information and a personal account only and does not replace the advice of your personal healthcare provider. This post contains affiliate links to help you find the products I personally recommend which may provide small compensation for me.

Rounding out this pregnancy-blogging adventure, I have had a rodeo of all the discomforts of third trimester to remind me what to warn other mamas is coming for them. I had forgotten a few of them, so it’s lucky for you all I decided to go for #3 to be truly up to date on all of this (jk). Every woman’s experience of pregnancy is different – you may get none of these, all of them, and then some more – but I’ve tried to hit the most common highlights here for reference.

Braxton-Hicks

These fun semi-contractions may have started earlier for you than 28 weeks, the official kick-off of third trimester. However, if they didn’t, most women will start to get them more noticeably now. You might start to wonder if these are “the real deal” and whether you should worry. In general, the main difference is BH contractions are a tightening not a pushing down sensation. Think a fist squeezing closed around something rather than trying to push down. It’s hard to know the difference until you’ve had the real thing sometimes, but trust me when I say – you’ll know the real ones when they come.

They can range from barely noticeable to quite strong, stopping you in your tracks. Talk with your provider about when to go get checked, but in general if you’re having more than 4 per hour despite resting and being hydrated with an empty bladder (I do realize those last 2 are hard to balance….), you should check in with your person.

Snissing

I learned this fun term in my first pregnancy and have been giggling about it ever since. Snissing is pissing when you sneeze. As that baby pushes more on your bladder and your pelvic floor loosens up more, you may start to lose control with episodes of pressure – aka sneezing, coughing, laughing, having a toddler jump on you…. Doing Kegels regularly through the pregnancy can help avoid this, but for some it’s your anatomy and you’ll just have to make do with wearing pads and prioritizing emptying your bladder very regularly. Hooray!

Hemorrhoids & Constipation

Everyone’s least favorite body part to talk about – your butthole. These are 2 separate issues but very related, so I’ll address together. Some lucky people (ahem, me included) struggle with constipation at baseline and pregnancy hormones make that so much worse. The worse the constipation, the more you might be straining to get that BM out. I mean this 100% literally: I have had multiple poops that were harder to push out than my actual babies. The more you strain the more pressure you put on the veins around your anus and at some point, they can start to bulge out – this, my friends is a hemorrhoid.

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What’s a preggo girl to do?? Stay aggressive about constipation management. Aim for 1-2 easy bowel movements per day. Talk to your provider about a regimen you can use, for me it’s been high-fiber diet, hydration with at least 2 liters water a day, Smooth Move tea most days and high-quality pre/probiotics. The best I’ve found are these Prolistic ones by Nerium, not just saying that because I work with the company, they are superior (link is not even for my own business to keep this separate).

Heartburn and Reflux and Vurping, Oh My!

Me after drinking orange juice

Downward pressure has it’s problems as above, but at some point the upward pressure gets to most people as well. Fun fact – the old wives’ tale that babies with more hair cause worse heartburn is for completely unknown reasons statistically true. The safest methods for managing this are natural:

  • Avoid large meals, don’t eat anything more than a few bites of a snack for 2 hours before bed.
  • Avoid acidic foods: coffee, tomato, citrus…
  • Manage constipation (backing up the whole system)
  • Avoid carbonation

Some people also do well with Papaya Enzyme after meals. And up to 6 Tums regular strength tablets a day are safe – but beware!! These can worsen constipation turning into a self-perpetuating issue. If it’s bad beyond that, talk to your provider about other antacids.

Aches and Pains

You can get upper back pain from the weight of belly and breasts, round ligament pain from your growing uterus, and low back pain from basically doing dead-lifts all day long with a 20lb plyo-ball. I read in residency that 80% of women experience back pain in pregnancy. That seems unreasonably low. I have never, ever talked to a woman who didn’t have some degree of back pain by the end of pregnancy. If you’re out there… what’s that like? What are you made of? Are you descended from Amazons? For the rest of us, a few things can help…

  1. Prenatal yoga. Exercise in general is helpful, but prenatal yoga in particular is INCREDIBLY important for the health and comfort of your back.
  2. Prenatal massage. Make sure you’re seeing someone trained in this specifically and with a table set up to accommodate a growing belly.
  3. Topical creams. Distracting the nerves with something tingly can help temporarily. My go-to is BioFreeze because it’s the tingliest (is that a word?).
  4. Belly and hip supports. See if you can get one through your insurance first, if not, the most popular ones are in This NY Magazine Review
  5. Warm showers or baths or heating pad. I say warm, I mean VERY warm. There is no exact temperature cut-off – just stop as soon as you feel “Hey, I’m hot”.
  6. Tylenol. Yep. That’s all you get. Plain tylenol. Always good to double check with your own provider if this is ok for you, but most pregnant women can take this for bad pain.

If your pain goes beyond what can be managed with the above, talk to your health care provider. Some will have you see a specially trained chiropractor who knows Webster technique, work with a physical therapist or use other medication to manage it.

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Labor Scares

We will do a whole post on ‘How to Tell When to Go To The Hospital”, but in short, many women experience bouts of ‘Prodromal labor’ or ‘False labor’ prior to the real deal.

  • Contractions: The Braxton Hicks can get pretty strong and somewhat regular towards the end and as prenatal providers, we get a lot of “When are they labor?”. The general rule is 5-1-1: if you have contractions that stop you from doing what you’re doing every 5 minutes, lasting 1 minute for 1 hour and getting stronger despite resting and hydrating, you should check in with your person.
  • Breaking Water: This seems like it would be straight forward, however, as explained above with Snissing, plus how much vaginal discharge you might have, it can be tricky. It is often not the Hollywood gush of a gallon of fluid that is obvious, but a slower trickle when your water breaks. If you’re not sure, go empty your bladder, put on a clean, dry pad and walk around a bit. If your water is broken, you’ll keep leaking. Still not sure – go get checked.

Cankles and Varicose Veins

It’s a cruel joke of the universe that just when it becomes super awkward to try to put on any socks, much less super tight compression hose, you start getting ankle swelling that is treated by exactly those socks. Do your best to wear them if you know you’ll be on your feet a lot and certainly if you’re traveling where you’ll be stationary in a car or plane for more than an hour at a time. There are lots of options with better breathability and cuter designs these days, these are affordable and the appropriate 20-30mm pressure rating.

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If you are able, also take 20-30 minutes a few times a day to put your feet up at heart level and let gravity help you out here. If you get the ankle, or in particular hand or face swelling that comes on suddenly, go see your provider right away as this can be a sign of pre-eclampsia.

I would be remiss if I didn’t also warn you that you can get swelling and varicose veins everywhere south of your uterus – including your lady parts. Some women have the special experience of these throbbing, painful veins or swelling in the vagina and labia at the end of pregnancy. While there are also some interesting medieval-looking support contraptions that can help with this, the main thing that will make it less-bad is resting on your side or in puppy-dog pose type position for 10-15 minutes throughout the day.

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Lightning Crotch and Sciatica

Ever get a reallllly good zinger plugging something in that the wires were a bit stripped or your finger was on the plug? Imaging that in your labia. Welcome to lightning crotch, the fun pregnancy-version of good ol sciatica. Both of these can happen as baby moves lower in your pelvis toward the end of pregnancy. The same things that help with back pain described above can help with these particular issues as well. Some people also find acupuncture very helpful – but again – check with your provider about if and with whom that would be safe to do.

Pregnancy Brain

Yes, you’ve probably had this all along. Scientists have actually figured out that part of this is due to the hormones circulating around. However, with third trimester, your sleep starts to be very disrupted – most people wake 3-6 times a night to change positions and go pee. This makes the fog worse, of course. My own theory though, is that it’s also due to the now much stronger little being inside your squirming around. I told my husband to try to imagine concentrating with a little elf riding around poking you, elbowing you, going, “Hey! Hi! It’s me! Hey-yo!! Yoohoo!! Hi!” allllllll day long. Now… What was I writing about here…? Oh yeah. Help yourself and write things down! Consider a tracking device for keys, make sure “Find My iPhone” is on and maybe slap some GPS watches on your other kids while you’re at it.

When To Get Help

There are 6 main things we never want you sitting at home with:

  1. Bleeding that is any more than spotting
  2. Concern your water has broken (see above)
  3. Persistent contractions (see above)
  4. Feeling less baby movement – there’s no perfect rule for this, if you’re worried, we are worried.
  5. Signs of pre-eclampsia: Persistent pain in the belly or back, headache, blurred vision, sudden increase in swelling of feet/hands/face, or difficulty breathing.
  6. Depressed mood or bad anxiety, or any threatening or abusive behavior from your partner. These all, sadly, go up in pregnancy – don’t stay silent! We can help!

The bottom line on this one is any time something is beyond a minor discomfort, we want to hear about it. Have a low threshold for asking for advice from your healthcare provider – we VERY much would rather you come in for something small than miss something big.

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Now, then… Who’s ready to have a baby??

 Dr. Annie is a family physician and 3 time mama in California.

 

Don’t Wash That Baby!

So, I know some of my Labor and Delivery or Newborn Nursery friends are gonna hate me for this post… but too bad, it’s important and our readers deserve the best information! I keep finding myself rushing to check in with friends and family who recently had a baby and try to catch them before the baby has gotten that adorable first bath. Such a cute moment! And the freshly combed wispy hair after?? Alllll the 😍😍.

The thing is, babies aren’t supposed to have a soapy bath so soon after their skin hits fresh air. Their skin has been protected in its own natural lotion called Vernix in a pH balanced amniotic fluid bath for their whole existence up until birth. It’s the most fragile and sensitive their skin will ever be when it first comes into contact with dry, cold air outside the womb.

My dad, a family doctor with a huge amount of experience, trained at a time when as soon as babies emerged from the womb, they were scrubbed down with chlorhexidine – a powerful antiseptic we use to sterilize ourselves before surgery.

It was thought at the time that this would “protect” them from the dangerous bacteria they encountered when they passed by your rear end. That was after the doctor had of course sterilized your vag with copious amounts of iodine solution. He told me this and my eyeballs very nearly popped out of my head. *GASP* The yeast infections that must have caused!! The superbugs that would breed!! NO WONDER so many kids have crazy allergies and autoimmune disease has skyrocketed!!

You see, I have been fortunate to be trained in the time of advances in the “Hygiene Hypothesis”. The understanding we now are working with is that, lo and behold, in the days before all this anti-septic overzealousness, those autoimmune and allergic issues (which are so freaking hard to treat, btw) were lumped into the “rare diseases” category. And while it’s great we now know to wash our food so we don’t all die of dysentery Oregon-Trail-style, we have certainly skewed too far into the anti-microbial realm which is boosting many if not all of these processes*. (In case you’re wondering, my dad was WAY ahead of his time and would not let this happen to his patients’ babies.)

SO back to that brand new baby. Current practice is to wash with your typical Johnson & Johnson baby wash within a few hours of birth. This makes it so that the health care team is not functionally putting their hands on something that came out of your vag when they come to check on baby. Also, it’s cute and baby then smells like what Johnson & Johnson have decided we should all believe a baby smells like. You get that white smooshy vernix stuff off so your photos don’t look like something out of a Halloween movie and everyone is happy.

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Rosie, fresh outta the womb and covered in blood and goo

…..Except the baby. It NEEDS that vernix still on there to protect it. There is no lotion on earth that can really replace that and a soapy scrub washes it all away. A review in Advances in Wound Care sums it up well*:

The retention of vernix on the skin surface contributes to a higher skin hydration, a lower skin pH, and relates to a reduced heat loss after birth

So, washing this off your baby is like slathering your face in a thick layer of Creme de la Mer and then immediately washing your face again to leave your skin naked and dry. But worse. Because you can’t buy more.

This is in addition to the absolutely critical happy bacteria (aka skin flora for the nerds like me) that you worked SO FREAKING HARD to put on your baby if you had a vaginal delivery or labored with your water broken. That “skin flora” has dramatic health implications. So much so that many hospitals are starting to swab mothers’ nether regions to coat the baby in them after c-sections too. A soapy wash kills up to 99% of those bugs and you may never get them back in the same way.

There are studies galore out there going on looking at the benefits those bugs go on to have on gut health, maintaining healthy body weight, absorbing nutrients, allergies, eczema, auto-immune disease and more. I won’t get over-sciency about this, but suffice it to say, we’re going to look back on this hyper-sterile era and cringe.

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Photo by Wayne Evans on Pexels.com

So is it a little weird to think about your baby being coated in all that stuff from your lady parts? Sure. Is it an extra step for the docs and nurses to put on gloves? Yeah. Is it still super worth it to wait a bit for that first bath? HellToTheYes. Bottom line, just wipe the excess gore off, wait at least 24 hours, and preferably do a gentle water wash when you get home. Thank me later.

I would LOVE your questions about this, comment below!!

 

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Dr. Annie is a Family Physician, mom of 2 with 1 on the way (nope, baby’s not here yet, that’s baby #1 over there, also, that’s my husband, not a creeper nurse, he’s a doc too so was working in scrubs when I went into labor) and lover of healthy bacteria in the Sacramento area.

 

 

 


*. 2015 Oct 1; 4(10): 587–595. doi:  [10.1089/wound.2015.0642] Skin Physiology of the Neonate and Infant: Clinical Implications. Teresa OrangesValentina Dini, and Marco Romanelli*

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.