Dr. Annie Answers: Preparing for the Worst to Enjoy the Best

Last January, the hubs and I were super lucky enough to live the parenting dream and getaway to Hawaii for a long weekend.Our good friends from college were getting married on the beautiful North Shore of Oahu. The kids were happily being spoiled with the grandparents and we were sipping mai tais by the pool at Turtle Bay resort.

26230814_10100186899024796_2515982490076519000_n.jpg

We enjoyed a leisurely dinner, we slept the whole night through – literally feeling like the luckiest parents on the planet. On the morning of the wedding, we were spending a lazy morning drinking coffee in bed when this came through on my phone:

26230699_10100186963201186_4106219119654183864_n.jpg

Jeremiah’s response was, “Are you sure it’s not a drill?”. At which point I hysterically screeched, “IT LITERALLY SAYS ‘THIS IS NOT A DRILL!!!!!!!!!!'”. I jumped up, threw on some clothes and dashed for the door while Jeremiah grabbed our backpack with wallets and we took off to seek shelter. The hotel staff were freaking out and had no idea where to send us but I remembered there was a basement level hallway down by the pool so I shouted for people to follow us and we ran down there.

As it hit me that we might be on our last 12 minutes on the planet, I was thankful for 2 things. One, we had a beautiful life together already. Two, I knew our daughters would be in good hands. We were able to send a quick text to my brother and his wife that we might be taken out by an incoming missile as well as to the grandparents and know that our little girls would be taken care of forever. You see, I had planned for this before we left. …well, not the ballistic missile specifically, but an in-case-we-are-both-taken-out-and can’t-care-for-the-kids plan, and communicated this to all important parties. Otherwise, this horrifically stressful moment would have been even worse.

We, rather belatedly actually, made an estate plan and formalized it on paper after baby #2 came along and parenting got real (Christiana is probably cringing reading that we didn’t do it before then). Do you have one? Chances are you don’t… Not sure where to start? My brilliant niece (who’s older than me… we have a crazy big family) has started a family law firm, Prunty Law, PLLC and just wrote her inaugural blog post about exactly this! She’s also a smart mama herself.

Caitlin Prunty

She writes, “As a parent to a new baby, you wouldn’t dream of putting your infant to sleep on his/her stomach with a fluffy quilt, because the worry of SIDS is upper-most in your mind, but the vast majority of new parents (and yes, some older parents too) have not made an estate plan that outlines who they want to care for that same precious child if they are no longer able to do so.”

It’s not as complicated as you would think. Does it suck to have to sit down and think about something terrible happening to both your spouse and yourself and someone else raising your kids? Heck to the yes. We do lots of sucky things as parents that don’t have nearly as important of results.

Caitlin lays it out for ya step by step, “If you haven’t had the conversation with your spouse/partner/co-parent yet, have it! Set time aside to discuss who you would want to care for your child if both of you are unable to do so.”. That’s right. You have to have a serious discussion. With multiple sentences back and forth. So… probably you’ll have to hire a babysitter for this one. I can hear you now, “But I don’t want to waste a date night talking about morbid stuff!!!”….

Get it over with. Like cutting the kid’s nails, the longer you put it off, the more likely bad things will come of it.

Back in Hawaii… 23 of the longest minutes of my life later, we got the second alert that the first one – the incoming ballistic missile alert – had been a false alarm. I’m sure whoever was responsible is now in witness protection if any of the other moms out there had the kind of rage I did. After some very stiff Tito’s and POG juice cocktails, we attended one of the most beautiful and emotionally charged weddings on the planet – handled in stride like only a pair of Hawaiians could:

Screen Shot 2018-07-08 at 9.53.37 PM.png

And when I got home, I hugged the living sh*t out of my little girls and cried and totally weirded them out. If you don’t already have an estate plan, head on over to Caitlin’s blog to get working on it. Like, today. Awesome.

 

At Home with Christiana: Thinking about that third baby?

As incredibly proud and crazy parents of three little ones, my husband and I have been surprised at how frequently we are asked about the transition from two to three children by families expecting or considering a third child.

What’s it like going from two kids to three?

How is the transition? Is it THAT bad?

Now, aside from wanting to throw my head back and laugh hysterically. Here’s what I would say to you if I had enough time sleep brainpower remaining to think through my answer…

grayscale photo of mother and three children playing

Life with Three Kids: The Good, the Bad, and the Ugly

The Good: Confident Parenting with built-in helpers

There are clearly any number of absolutely joyful and miraculous things about bringing a baby into your family, regardless if it’s your first or fifth. Here’s what we found were the strong points of our ‘third baby’ transition.

beautiful blurred background casual family

  • Your other kids already have a companion

Your first child had no one else play with but you when you brought home newborn child #2. In my case, I breastfed our babies. Trying to actively engage our first child (who was still a toddler in his own right) while simultaneously nursing our new baby was a big challenge for me. With baby #3, I found this aspect of the transition much easier. My two older boys were already happy to ignore me for blocks of time while playing legos or dress up with each other, so playing together while I was nursing or tending to baby #3 wasn’t a huge deal for them.

 

child wearing white crew neck shirt

  • No only-child adjustment

The change from “only child” is non-existent for your first two kids when you bring home baby #3. Your second child came into this world sharing the spotlight with his/her sibling, and your first child is already settled into the role of big brother or sister. Of course, every child is different, but I have observed among our family and friends that adding the third child is less of of a shock, than it was bringing home #2 for the first-born who enjoyed a window of time as your only child.

 

  • Not your first rodeo

With baby #3, I was much more confident in my abilities to notice problems and make the right decisions for my baby’s well-being (OK I still had Dr. Annie on speed-dial, but maybe less frequently.). You have a lot more experience going into your third baby, and it made me more self-assured as a mother and I was more comfortable trusting my instincts.

 

love cute kids baby

  • You have a little helper

Your oldest has a few more years under their belt and is capable of being a much bigger help this go-round. Having a big enough kid to hand-feed their sibling puffs in the back seat of the car is. priceless.

  • Baby-weight schmaby-weight

I remember being completely terrified of my postpartum body the first time around. Would I ever be the same?! Is this even me?! Whose boobs are THESE!?

By baby #3, you know your body can and will rebound from pregnancy. Plus, you won’t have time to sit down or eat an actual meal anyway. So it often comes off fast. Trust me.

The bad: Tardy multi-tasker

I hesitate to even use the word “bad” here, and I’m not saying by any stretch of the imagination that having three children is any way bad. To the contrary, I think having three little people is total awesome-sauce.  BUT,  if we are being real here, I think we can all agree that there are some situations that you just don’t feel good about when they happen, in fact you feel rather bad. And these situations mentioned below, I have found to occur more often with three or more children in tow. Just keeping it real.

  • The call of nature will sabotage your on-time arrival, anywhere.

Someone will need to poo at the exact moment you need to leave the house.  I’m serious. Every. time. Just go ahead and set your alarm to leave  a few minutes earlier, it won’t matter. They’ll wait. And they’ll still “haaaaave to go!” at the time of departure. Nature: 1. On-time arrivals as a family of five: 0. Just don’t fight it.

baby newborn born sleeping
“Must be time to pick up my brother!”
  • Someone will nap when and only when you have to pick up or drop off another child.

This is enough to make a sleep-deprived parent of three want to put their head through a wall. But it’s infuriatingly true. The ability of your third baby to set their nap schedule to directly conflict with your other children’s schedules is uncanny.

  • Referee, shoes, snacks… and baby 

You will have to do everything for baby #3  that you did with baby #1 and baby #2, except you will now need to do it while either (1) refereeing your other children;  (2) frantically looking for your other children’s shoes; or (3) making a snack. No exceptions.

The Ugly: Exhausted germaphobe

  • NO. SLEEP.

For me, the ugliest part of adding baby #3 was lack of sleep. If you have your children close together, (ours are each 2 years apart) you still have little people that may have trouble sleeping through the night, or need reassurance that they are still your babies too (which often, for us, translated to mommy or daddy hugs and tuck-ins at random hours of the night). There’s no way to make it easy, but if you can try to remember that it will pass rather quickly, and even better if you have a partner or family member that can help alternate/take shifts, you will get through. Take any ALL of the freezer meals and offers to walk to your dog or pick up your other kids. It really takes a village, especially when you’re running a three child circus.

  • School germ-warfare

With baby #3, you will have two germ-covered angels coming from school or daycare everyday sharing a home with your new baby. You will, without a doubt, look down to help one child with a shoe/band-aid/tissue/whatever and look up to see your other child’s germ-covered finger/backpack strap/shoe-lace in your baby’s mouth. You can no longer run man-to-man defense. You just can’t. This sent me into complete germa-phobe mode. I surrounded our baby with bottles of sanitizer and shouted “pump before you touch!!” like a crazy-lady.  And sometimes no matter what you do, baby will get colds, (and no one will sleep) but all you can do is your best. And in the meantime buy sanitizer for your car, your purse, their backpacks, and every room in your house.

Did you know James Corden and Stephen Colbert both have three kids? They do. And they sum up the transition from two kids to three with incredible accuracy and humor here. If you or anyone you know is even thinking about baby three… Watch. This. First.

In sum: We are crazy. But happy. Usually.

Life with three kids is crazy, messy and busy, but it’s also beautiful, amazing, and (usually) really happy too.  Watching our boys dote on and care for their little sister makes our heart explode on the daily. (When they’re not beating each other it turns out they can be kind of sweet?!?) The dynamic of three kids is really special (and mostly fun) already and we can’t wait to see it grow.

Your hands will always be full, but so will your heart.

IMG_3716

 

fullsizeoutput_658Christiana is a Navy wife and mother of 3, attorney and former realtor, world traveler, home renovator and decorator, yogi, fitness enthusiast, and recipe and fine wine explorer.

 

 

 

Photo credit: Tara Liebeck Photography

Dr. Annie Answers: Getting Pregnant

pexels-photo-59894.jpeg

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!

When to get off birth control…medicine-thermometer-tablets-pills.jpg

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.

pexels-photo-41068.jpeg

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.

IMG_0179
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 😀

94

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

Dr. Annie Answers: Birth Control Breakdown

This has been and still remains one of my all-time favorite conversations to have in my clinic. There are so many options for birth control these days, it can be a little overwhelming to know what is right for you. Even condensing it, it’s a long post, but hopefully you or someone you know and share it with will get some good background info to go get their safe-sex groove on. I’ll be sharing more detail on each category in future blog posts, don’t worry!

**This blog post, ofcourseofcourseofcourse does NOT take the place of a thoughtful conversation between you and your OWN doctor about what is the best choice for your particular health needs. I am not your doctor.**

I like to break the options down into bigger categories to keep it straight. With each I will give you the ‘failure rate’ for ‘typical use’ – aka if 100 normal women have a sex regularly for 1 year, this is how many will get knocked up (reference here). Here’s the big picture with color gradient for how frequently you have to do something to prevent pregnancy:

Screen Shot 2018-04-17 at 9.10.20 PM

Important side-bar #1: IF THIS POST IS RELEVANT TO YOU, YOU SHOULD BE TAKING A PRENATAL VITAMIN! Yes, I understand that you are looking at birth control because you don’t want to have a baby. Take one because IF you get pregnant despite these interventions, and there is a any spec of a chance in the universe you *might* keep the baby even to give it up for adoption, the vitamins need to ALREADY be on board. Like 3 months ago. Take one. Any of them. Don’t care if it’s a gummy.

Non-hormonal

The two most broad categories of contraceptive options are those with hormones versus those without hormones. I’ll start with the latter because there aren’t many (hey researches, hellllooooo??? can you get to work on this please??). There are a handful of reasons that people might need to use contraception without hormones (history of blood clots, certain cancers in the family, bad reactions in the past) or you might just want to avoid the exposure for personal reasons.

The Copper IUD aka PARAGARD®: Less than 1 in 100

Screen Shot 2018-04-17 at 1.03.26 PM

Did you notice how reliable this one is? Also, it’s good for up to 10 years with absolutely zero effort involved. AND, if plans change after 1 year and you want a baby? So easy to remove, no hormone wash-out period, so you can get pregnant right after. OK, ok, I know. Intrauterine devices have a lot of bad press. I will write a whole separate blog post with more details, suffice it to say complications and adverse reactions are RARE, only about 15% of women have theirs taken out in the first year for any reason.

Rhythm method or Natural Family Planning: 24 in 100 (about 1 in 4)

The reliability of this is INCREDIBLY variable. IF you have extremely regular cycles, AND you are meticulous about tracking AND you can avoid sex for 2 weeks at a time depending on the cycle, it can be close to other methods’ reliability. There are very few people who achieve this. In medicine we say, “what do you call people who use NFP? …. parents.”. That being said, if you wouldn’t be excited to be pregnant, not the best choice.

Barrier methods: 18 in 100 (about 1 in 5)

This includes condoms (also the only thing that prevents STDs) and diaphragms (yes, some women still use and love these). Not many people still do the sponge for a variety of reasons. There are new and better condom makers, vegan, non-toxic, etc… They still have a relatively high rate of failure due to tears, slipping, forgetting to put on at the right time… In my professional opinion, condoms should be used as STD preventers, NOT as contraception because 1 in 5 is HIGH failure rate, ya’ll! Fun guide to condoms in This Women’s Health Magazine Article.

Hormonal

There are a few advantages to hormonal methods – mostly involving period and, well, hormone regulation. Like I said above, there are some health conditions that influence the decision here, talk to your doctor. I also break this down into two larger categories: Combined estrogen/progesterone and progesterone-only.

Progesterone-only

The IUD squad: Mirena®, Liletta®, Kyleena®, Skyla®: Less than 1 in 100

No, these aren’t the top 4 up-and-coming baby names of 2019, these are the 4 varieties of Progesterone IUDs. The Mirena and Liletta are the classics – differing only in the insertion device we use. Good for 5 (under testing for up to 7) years. The Kyleena has slightly less progesterone and the Skyla has even less and is 0.1 inch smaller, but you only get 3 years here. Procedure is the same as copper IUD. The lower the progesterone, the more likely you are to have irregular bleeding.

Screen Shot 2018-04-17 at 6.32.11 PM

All of these usually decrease or eliminate your period bleeding. YAYYYYYYY!!!!! NO PERIODS!!!!!!

Important side bar #2: “But don’t I have to bleed? That seems unnatural…” N. O. No. Think about this: if your body had NO contraception and we were living the ‘natural’ life of our ancestors, you’d be pregnant or breastfeeding for most of your fertile years – aka, no periods. Your body is actually made to have fewer periods than most of us do. There is a slight decrease in the rates of endometrial and ovarian cancer with suppressing cycles, and NO negative health impacts.

Nexplanon (formerly known as Implanon): Less than 1 in 1000

No, that’s not a typo, failure rate here is 0.05%. That is 10 times more reliable than a tubal ligation. This is a tiny, flexible medical plastic device that goes under the skin of your arm and releases a steady, tiny amount of progesterone for up to 3 years. To get it in, we numb up your arm and then use the handy-dandy (nearly) foolproof inserter to put it in and release it.

Screen Shot 2018-04-17 at 8.25.53 PM Implanon isn’t used anymore because the inserter was NOT foolproof and some implants were put too deeply, and it wasn’t visible on x-ray so was really hard to get back out. They fixed both issues for Nexplanon.

Depo Provera: 6 in 100

This is an injection of progesterone you get every 3 months. It’s cheap, it is likely to wipe out your periods BUT has a high rate of side effects and you have to remember to go in every 3 months, so not my highest recommendation. However, some people like it. We usually recommend it as a short-term solution while you’re deciding on something else – ie: to buy you 3 months to convince your husband to stop being a weenie and go get a vasectomy.

Progesterone-only mini pill: 10 in 100 or more

I generally only recommend this one when you are breastfeeding (NOT pumping, but direct breast feeding) full time in the first 6 months of your baby’s life. It is otherwise very unreliable and if you miss taking your dose by even 2 hours, you can get pregnant.

Combined Estrogen Progesterone

Important side bar #3: If you’re somewhere in life that it is hard to get birth control – ie without insurance, without a primary care doctor or without any doctors in the area you live in, there’s an app for that!! Check out This NPR Article about it (yay for progress!!!).

Pills: 9 in 100 (if you remember)

Pills are the old standard of birth control. Easy to get, easy to start, easy to stop. Side benefits may include skipping your periods if you choose, better skin, hormone regulation. However… you have to remember them. every. day. I barely manage to brush my teeth every day. If you are that unicorn person with no problems with this, awesome. If you’re more like me? Think about another option.

The morning after pill – aka Plan B One Step – is something that everyone without a longer-term option (ie IUD or Implant) should know how to get or keep on hand. It does NOT cause abortions, contrary to the fake news out there, but CAN prevent an egg from being fertilized or implanting if you get to it asap (ideally within 3 days, but up to 5) of an “oops”. You can buy at any pharmacy in most states or on Amazon: Plan B One Step

Patch: 9 in 100

The patch is 7 times easier to remember than the pill and you get some decreased side effect due to the transdermal absorption which skips the gut/liver processing. Works great for a niche audience who doesn’t mind the patch being there.

Nuvaring: 9 in 100

Screen Shot 2018-04-17 at 8.41.00 PM

The Nuvaring is a flexible ring that you put in your vagina (a la OB applicator-less tampons) and leave for 3 weeks.  So, 21 times easier than the pill. Again, lower side effects and hormone dose than the pills because you absorb directly into the bloodstream instead of through the gut/liver. You can leave it in during sex (some people find it stimulating in a good way) or remove for up to 3 hours, rinse and replace. This one is a great option for when you need something easier than the pill but aren’t ready to commit to an IUD or implant!

Things that are not birth control:

  • Pulling out. Not even ‘pull out and pray’.
  • Spermacide alone (1 in 3 failure rate)
  • Having sex during your period
  • The first time you’ve ever had sex
  • A quickie
  • Having sex in weird positions

person-couple-love-romantic.jpg

Wow, that was A LOT OF INFORMATION!!!! I’m sure you have questions… ask me, ask your provider. Don’t ask people who don’t do women’s health as their profession, just, please, trust me on this one. Now, go get your safe-sex on, HEY-YO!!!

Momday Faves: Part Deux

To continue a “few of my favorite things” on these Momday Faves list….

Kristy’s turn:

Mommy Hooks

toomany bags

Does this look like you running errands or enjoying a day out with kids in tow…one in a baby wearing device, one holding hands, and one in a stroller? Trying to run errands, go to the farmers market, store, zoo,shopping mall, anything can be overwhelming when the “stuff” piles up.

“mommy hold this” twice from each kid….plus picking up that package from post office and the flowers that I told you to buy for yourself a few posts ago…..

Heres your solution…The Stroller Hook!

Screen Shot 2018-04-15 at 8.00.55 PM.png

This one, by Toogli, is one that I like but there are several comparable brands to choose from here: Hook Options

This lovely thing clips ALL YOUR BAGS into your cart, stroller, backpack, wherever you want it! Its a heavy-duty carabiner that saved my life with two kids, a diaper bag, a baby wearing device, all the coats, shopping bags, etc!

Home Meal Delivery 

I am way into things arriving on my porch, ready to be made! Taking my kids to the store ended up getting extremely expensive for a family of four who eats wants to eat a paleo diet. We found Sunbasket.com and have LOVED every box we’ve gotten. They have very healthy options, and it saves us the time and money of getting all the ingredients at the store. Most of you know Blue Apron, but Sun Basket offers organic, free range, and different options for different dietary restrictions.

ddd757f0-0e97-4c76-b468-216fdfea69a4

For the price point, we’ve found Sunbasket to be the most convenient and the most excellent. As cross fitters, we need to focus on the fuel we put into our bodies daily.  With our schedules as they are, we wouldn’t eat as healthy as we do without Sunbasket.  Give it a shot!

And finally, a HUGE thank you to all of you who promoted our blog and got us to 50 followers. Keep sharing the good news and we will keep posting fun/informative/inspirational/random stuff!!

sunset-hands-love-woman.jpg

 

Dr. Annie Answers: Momxiety

For as long as I can remember, I wanted to be a mother. As a child, I have clear memories of poking my little tummy out with a stuffed animal in my shirt, pretending to be pregnant.

Fast forward 20 years, I was married, at the end of residency, my 3 best friends (the other illustrious ladies of Lockers to Littles) had all just had their first babies and I got THE FEVER!!! It took 5 months (which is not actually a long time at all but felt like forrrevvvverrrr) but it happened! I was pregnant!

545504_653943894176_1689591534_n.jpg

That was where the excitement ended. I got morning all day sick from week 5 that was relentless. If you’ve had morning sickness – now imagine having it while having to examine infected toenails of vagrants or while talking to a chain-smoking person into quitting or while a woman in labor is herself vomiting and pooping on the bed. I lost 15 pounds in my first trimester.

Then came headaches, insomnia and fatigue combined, sciatica, pubic symphysis pain, round ligament pain so sharp I would cry out, then premature contractions and labor scares. I was NOT basking in my joyful pregnant glow. I was confronted day to day with women with infertility, pregnancy loss or worse so I felt unbelievably guilty about any negative pregnancy thoughts. But I. was. miserable.

394799_663859942336_1304810692_n.jpg

At 39 weeks 3 days of pregnancy, I was still having on and off contractions as I had been for 2 weeks. During my morning clinic, they got progressively stronger and were coming every 5 minutes. I called my afternoon clinic and told them I wouldn’t make it. Rosalyn Elizabeth was born 12 hours later. I was so excited! Labor and birth had been (relatively) easy for me. My baby latched well. I was finally going to get my motherhood bliss on!

735077_663767542506_803843932_n.jpg3 days later, post-partum anxiety and depression hit. Hard. I naively thought since I was used to working 30 hours at a time with no sleep that having a baby wouldn’t be that much worse. But, in parenting, there is no “post-call day” that you sleep for 8 hours and recover. Hormone sh*% hit the fan and I remember sitting up in bed in the night, tears streaming down my face, seriously contemplating leaving the baby with my husband and running away to Mexico. I wanted this baby so badly, but I had never been more depressed. What was wrong with me??

I thought I had “baby blues”. I struggled through. I hated motherhood. Week 6 hit and I had to go back to work. I couldn’t stop crying and was in a panic about how to get through a day of clinic when I broke down doing things like making toast. The day before, I scheduled a last-minute appointment with one of my attendings (the boss-doctors). It finally dawned on me that she had given us a lecture on post-partum depression. She had admitted that she had it too.

We had both been taught – AND taught others – about this but fell into it without recognizing it ourselves. I started Zoloft and though it’s physiologically not possible for the full effects to kick in that fast, within 2 days I was well on my way to being a (mostly) normal person again.

539881_667477218286_2026859594_n.jpg

When you are in the depths of that kind of depression and anxiety it is nearly impossible to even recognize there is another way to be. Of course you worry about your baby. Of course you feel guilty for not getting things done the way you used to. The issue is when this prevents you from living a relatively normal day to day life.One in seven women will experience postpartum depression. There is a lot More Information In This AAFP Article. It can hit any time between 1 day post-partum through the first year, but the peak is 2-4 months of baby’s life and it can harm not only mom but baby too. It’s harder for bonding, breastfeeding and nurturing when mom is suffering from PPD.

The screening tool for depression we use is SIGECAPS:

  1. Sleep issues? check.
  2. Loss of interest? how could you possibly do anything fun when the baby takes all your everything, so check.
  3. Guilt? Oh man, there is no guilt like mom-guilt.
  4. Decreased energy? duh.
  5. Lack of concentration? what was the question?
  6. Changes in appetite? Does EAT ALL THE THINGS count as appetite?
  7. Psychomotor retardation (aka do you move slowly)? Took 2 hours to get dressed, so, yeah.
  8. Suicidal thoughts? This one is less universal. But was there for me. Never in an active way, but did I think “wouldn’t they be better off without this useless lump of human?”, yes. I did.

A few positives, some of the time, yes, is “baby blues”. I hit all of the above. every. day. of that time. But I still couldn’t imagine a happier me. So when that serotonin finally hit my struggling brain cells, it was an absolute revelation. I wanted to shout from the rooftops “YOU DON’T HAVE TO FEEL THAT WAY FOREVER!!”. Yes, I still worried about my baby, but I no longer stayed up for days on end because I was convinced she would stop breathing in her sleep. Yes, I still felt a little guilty about not getting stuff done, but I no longer felt like the world would be better off without me if I didn’t get the laundry done.

That’s the thing about depression and anxiety treatment – it’s not meant to make you a zombie or to fix all your problems. The medicines correct imbalanced brain chemistry. The therapy helps you retrain your wayward thought processes. Treatment helps you get back to normal. In the case of moderate to severe symptoms, the fastest and most effective course is usually both therapy and medication. The medicines is safe (even while breastfeeding – in fact it sometimes increases milk supply). It does no harm to your long-term mental health. It is not addictive. It may actually save your life.

200656_667477722276_1458301559_n.jpg

There are a lot of resources for parents with anxiety and depression, but the most direct access to care is usually your primary pregnancy care provider. Your family doctor, OB or midwife can help you get therapy, medication and other treatment or testing. If this is you, ASK for help. If this is your friend, partner, sister, colleague – share this story with them.

As you may have noticed, I got “momnesia”, forgot all of the above misery and decided to have another baby. I had been able to wean off the meds after about 6 months and was back to my usual crazy awesome self. This time, week 2 post-partum, when the all-day crying jag hit, I knew what to do. I called my doctor and got on my Zoloft right away again. Wouldn’t you know, it went so much better, now I want a third baby!  I could never have been as effective of a primary care doctor myself had I not gone through all of this. We live and we learn and life is a beautiful adventure that way.

94
Photo credit: Fiona Margo Photography fionamargophotography.com

Annie is a married mother of 2 and family physician in California.

Potato, potato and other messages from above

So, part of what led me to this awesome blog adventure is an ultra-inspiring book called The Universe Has Your Back: Transform Fear To Faith by Gabrielle Bernstein. The book plopped into my life at the exact moment I needed to hear her message: don’t let fears about the future stop you from following your passions.

Meditation and positive thinking have been shown to have very significant positive effects on all sorts of aspects of one’s health. And, I’m not just talking about mental health. In this study published in 2015 in the International Journal of Cardiology by CM Dubois et al on patients with coronary artery disease a meta analysis “showed  that positive constructs were associated with reduced rates of rehospitalization or mortality”. Let me break that down for you – if you had a positive outlook, you were less likely to have to go back to the hospital or DIE from your heart disease. There are similar findings for diabetes, arthritis, and of course depression, anxiety and all sorts of psychiatric disorders.

I had lived in fear about the time commitment of writing a blog, even though I knew it would be fun and fulfilling for me, for literally, years. Letting go of that fear was obvious. My Our decision about baby number 3 was more difficult. You see, even though my ovaries and soul (are those the same thing? a question for later….) were crying out for more, my level headed hubby was quick to point out all the reasons not to rock the boat. I couldn’t figure out if it was fear or logic holding me up.

I decided to sit down with one of Gabriella’s meditations where you clear your mind and ask [The Universe, God, Uncle Tony (if you’re my mom)] for a clear sign that you’re on the right path guided by love and joy. Having done yoga and meditation for about a decade, I still struggle to clear my mind every. dang. time I start a meditation. But, not this time!! When I wanted something to *pop* into my mind as my sign I’d look for, nothing. Blank, black, peaceful nothing. And then, finally, clear as day, this roars into my head:

“Potato potato, ching chong tomato!”

Um, excuse me Universe? That’s my sign?? The absurd line from an insomnia meme I looked at 3 days ago??  At the same time, I realized the Universe was probably looking at me going, “Really?? How do you expect me to pull that one off? Most people pick owls or the numbers 1234.”

Screen Shot 2018-03-21 at 12.01.25 AM.png

I decided to go for a second sign. Peanuts! I always think of little babies as a peanut. So, peanuts in the shell seemed like a much more doable sign.

On went my life in a bit of a blur. The usual day-to-day was extra-challenging because Noemi got the dreaded post-cold-ear-infection and was miserable and so clingy and whiny (and yes even doctor moms stress about whether their kid does or does not need antibiotics). Today, FINALLY, she was well enough to go back to preschool and I got to go to the gym and the grocery store without a child in tow – basically a mini-vacation! As I waltz through the grocery store in my post-workout chill, I am contemplating, “how in the heck am I going to find ‘potato, potato, ching chong tomato’?”. Maybe my sign was getting an ovarian cyst a month ago and that emotional breakdown and I am overdoing it asking for a specific sign… Suddenly, I’m starving and head for the deli section. And stop dead in my tracks.

The middle prepared food cart has, in this order, french fries – mashed potatoes – 2 containers of crappy “Chinese” food – and tomato-vegetable soup. I kid you not. Potato, potato, ching chong tomato. I almost keeled over in shock. Then, I immediately was mortified and mentally berated myself that I had associated the Chinese food with “ching chong”. I quickly convinced myself I was reading too much into this. In a daze, I ambled over to the produce aisle, where I ran smack-dab into the large display of…  peanuts in shells. Well, butter my butt and call me a biscuit. You could have knocked me over with a feather. (I start talking in all my mom’s southern sayings when I’m in heightened emotional states, it’s not something I can control).

So, friends, moral of the story is: If you’re unsure that you’re following your joy and a decision is right for you, ask for a sign! Make it specific, and then be open to find it. If it’s meant to happen, the Universe will find a way! And also, this blog will, probably at some point in the next year, feature my pregnancy stories if I am reading the signs right 😉

My favorite app for guided meditations is the Insight Timer (they don’t pay me). It is free, has thousands of guided meditations from 1 to 90 minutes long and also just a timer setting for quiet meditation.

IMG_3257
Last pregnancy, delivering babies at 36 weeks!