A Modern Day Village: The Birth Worker’s Inspiration

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I recently had a conversation with a client who is about to be a first time Grandmother. As I listened to her speak about her worries about her daughter’s upcoming birth, her struggles during pregnancies with depression and Hyperemesis Gravidarium, I was completely struck by the feeling of isolation that she was describing in her daughter. She is the only one of her friends pregnant, and although she does have a Fiance, he is  not operating on the helpful wavelength that she needs.

Immediately, my head swirled with questions to find out more.

“Who did this new soon-to-be-mama have to ask questions to other than the doctor she sees once a month?

Why is no one there for her other than her mother? Is the doctor leading her to support groups, mothering circles, moms with prenatal or postpartum depression? What will she do when she actually HAS the baby? If she’s struggling with depression now, who will watch out for the signs/symptoms of it in the postpartum months? Who will help this woman!!!!!!!??????”

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A little voice in my heart spoke up right then.

You, silly. You’re a birth doula. You have all she needs. Help her.

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Almost moved to tears, the words fell out of my mouth reflexively. “I remember those feelings all too well in both of my pregnancies,” I said sympathetically. “It sounds like she could use a birth and postpartum doula.”

The only difference between this mama and me when I was going through those same terrible feelings while pregnant was, I wasn’t actually alone. I had my doula there one phone call away at any moment. I had the cohesion of care between my amazing midwives, my doulas, myself, and my team. I had created my village.

After explaining what a doula is and does to her, (if you still want to know what that is, reference my Demystifying Doulas post here) it occurred to me that in some cases, women have no idea of the need for a village.

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Photo Cred Doulamatch.net

Back in the day, we lived in literal villages that would commune together for the birth of a new village member, and either call the midwife or have one on hand. 9 times out of 10, the birthing mother had a sister, mother, friend, neighbor, SOMEONE, with her until the midwife could arrive to her. Thus, the doula is born. Even female elephants know the importance of gathering around to form an impenetrable barrier of support for the birthing mother. I frickin’ love elephants.

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While modern-day women and birthing communities are certainly bringing doulas back, there is still too large a proportion of women who go unsupported during the pregnancy, birthing, and postpartum process. Why, you ask? Mostly because, they do not know we exist. It is the lack of conversation, or the lack of clarity on our exact role, that I sadly have to believe is one of the main reasons that birth has the potential to be such a traumatic experience for some women.  Having the guidance of your doula to shepherd you into the parenting life with grace, provide you with materials to support you every step of the way, can provide you with your lifeline if when you need it.

A glorious benefit in making the choice to hire a doula is that he/she may in turn lead you to your permanent, modern village.

Truth is, the years of preconception, pregnancy, transitioning to becoming a mother of one, two, three, multiples, etc., can come with many mixed emotions. No matter what your situation turns out to be when you find out you are pregnant, the feeling of isolation can be sudden and agonizing. When hiring a doula, you’re not only receiving the personal care of a hands-on teammate in your birthing journey, you are also DSC01327choosing an expert in community, local resources, birth education, knowledge of primary care givers specific work, and access to birth related evidence, articles, and, yes, even a postpartum sounding board. The doula will, in essence, be your trail guide for navigating the rough and unknown waters of this new chapter.

It is time, now, that we stop isolating ourselves as mothers. Let’s remind our world that we have been supporting each other proudly and strongly for…well…since the dawn of humankind. We do not need to do it alone. It may feel too daunting a task going to these mothering circles full of strangers, organizing birth class dinners at your house, or even seeing a therapist to get the necessary prescriptions to aid you. What if, in lieu of uncertainty of the support you need, you could Call. Your. Doula.

We can support this adventure every step of the way. We are here, so that you can be here and present through the whole process.

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Now that I have you convinced of the awesomeness of unconditional education and no-judgement support during your birthing years, let me illuminate the steps necessary to finding your perfect doula.

  1. Ask a friend: Ask around for a connection or connect with the doulas in your area by using the ultimate doula search engine: Doula Match  
  2. Interview a few: Find the right candidate by sitting in the energy of several different people.  Remember, you are hiring for a job, so the right fit is important. Birth is a vulnerable experience, so pick someone who will make you feel completely safe, who makes you feel confident, and someone by whom you and your birth partner feel empowered.
  3. Ask all the questions: Make sure you understand their vision of care, fees, and schedule and those align with what you had in mind for your birth vision. After all, it is your birth, the team you hire should complement it in every way with encouragement and advice that makes you feel informed. Do you want a doula just for prenatal education and birth? Do you know you’ll need postpartum care? Do you even know what that means? Does this person have the resources for all of that?
  4. Contract: You should always enter into a contract with your doula. That way there is an expectation of care that is agreed upon by all parties. This agreement is key, as mentioned above, it will be the catalyst for your new life as a mother.
  5. Get excited: Your doula should help you feel connected to birth classes, books, and other materials to prepare you for your upcoming experiences and all outcomes!

We all need the help. It is up to us to choose, in this modern world, just what our helping hand will look like. Most of us consider this calling a service to womankind alike. I am here to let you know it’s out there. I am writing to speak aloud that we are everywhere. We are your friends, neighbors, sisters, mothers, co-workers and colleagues, gym members, professionals, and tradeswomen.nature.jpg

We are your village, and we are here for you.

Kristy is a doula, massage therapist, energy worker and mom of 2 in Virginia.

 

Dr. Annie Answers: Plastics & Poisons, what the AAP statement means for you

Parenting life is full of trying to balance our desperate, borderline insane level of worry about our children’s health and wellbeing with just getting through the day with everyone alive and fed. It can be so hard to know which of the internet warnings are worth the extra effort in an already chaotic day and which are probably overkill. Even for me – a board certified physician. A recent biggie just came out that I want to break down for you all – plastics and food processing. As always, this is general information – if you have questions, ask your own health care provider.

The AAP Statement

In the August issue of Pediatrics journal, the American Academy of Pediatrics (AAP) issued a statement “that some chemicals found in food colorings, preservatives, and packaging materials may harm children’s health” (See full article and references here “Food Additives and Child Health”, published online July 23). They recommend that some chemicals which are currently allowed in US products and food processing should probably be avoided whenever possible.

Bisphenol, phthalates and dyes, oh my!

“What are we worried about this time?” you might be asking. Some of these have been on the watch list for a while, others you may not have heard of before. I’ll give a super brief run through here derived from this AAP review:

  • Bisphenols: This includes the dreaded BPA. In hard plastic containers & metal can lining. Can act like estrogen and mess with  puberty, fertility, body fat, and even affect the nervous and immune systems. BPA is now banned in baby bottles and sippy cups, but other bisphenols are not (yet).
  • Phthalates: Used to make tubes used in industrial food production flexible. These “may affect male genital development, increase childhood obesity, and contribute to cardiovascular disease” . Also banned in some products such as teething rings – AAP is working on more bans.
  • Perfluoroalkyl chemicals: That’s a mouthful – aka PFCs. Used to grease-proof food packaging, “may reduce immunity, birth weight, and fertility”. Research shows PFCs may affect the thyroid also.
  • Perchlorate: This is added to some dry food packages for static electricity control. Can “disrupt thyroid function, early life brain development and growth”.
  • Artificial food colors: Yikes guys, in so many “kid foods”. These may be associated with ADHD symptoms and research shows cutting them out made ADHD symptoms less in many kids
  • Nitrates/nitrites: Food preservatives and used to enhance color, especially in cured and processed meats. These can mess with thyroid function and blood oxygenation. Also have been linked with gastrointestinal and nervous system cancers.
  • (See AAP review here for info/references on each of these)

Um… so that’s scary

Action Items

You can take some simple steps to get these out of your kid’s and preferably your own life ASAP – especially if you’re pregnant.

1) Go Fresh

Get fresh or frozen meats, fruits and vegetables rather than canned, processed or preserved. More and more alternatives to canned goods are now available in safely packaged boxes or pouches instead. Here are a couple of my go-to’s – added bonus, no can-opener needed and they look super cute in your pantry stacked up:

Pomi Finely Chopped Tomatoes - 26.4 oz (4 Pack)Green Valley Organics Black Beans Pouch, 15.5 Ounce (Pack of 12)

Green Valley Organic Bean Pouches and Pomi Tomato products in boxes.

All Beef: Healthiest: Applegate Naturals Beef Hot Dog

For meats, it is worth eating a little less and spending a little more when you do to get all natural, organic and/or grass-fed. Look for deals on these, stock up and freeze. Or better yet, follow Kristy’s lead and invest in a partial butchered animal.

2) Upgrade your containers

Use alternatives to plastic, such as glass or stainless steel, when possible. If you can’t afford to replace your food storage (tupperware, etc…) and sippie cups right now, at least avoid microwaving food or beverages (including infant formula and pumped breastmilk) in plastic. Also avoid putting any plastics in the dishwasher. If you can afford an upgrade, here are some great products for kids:

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LunchBots bento containers $41.99: dishwasherable, different colors and safe and

PlanetBox ROVER lunch bento boxes $79.95: A little pricier, also keeps food more segregated.

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Snapware Total Solution Pyrex Glass Food Storage Set, 24 pieces $55.99:

These go on sale at Costco regularly – nab one or two sets and let go of your old plastic ones!

 

Dr. Brown's Options 3 Piece Wide Neck Glass Bottle in Silicone Sleeve, Green/Mint/Blue, 9 OunceJoovy Boob Glass Bottle and Sleeve, Blue, 8 OuncePhilips Avent Natural Glass Baby Bottles, 4 Ounce (3 Pack)

Baby Bottles: There is a great blog post here on Gentle Nursery about this alone. Three good options to try are Dr. Brown’s, Joovy Boob and Avent. I always recommend buying 1-2 of each of a few different bottles to see which your baby prefers.

BravaWare Stainless Steel Cups and Silicone Sippy Lids for Kids Toddlers Babies BUNDLE: 4-8oz Cups and 4 Sippy Lids - BPA free Sippy Cup Set with Safe Rolled EdgesMunchkin Miracle Stainless Steel 360 Sippy Cup, Blue, 10 Ounce

Sippie Cups: There are lots of options for cups with straws in glass and stainless steel. These two are great sippie cups – BravaWare and Munchkin Miracle. IMHO, if you’re handing a cup to a kid, probably best to avoid glass until they’re older, even if it has the nifty silicone protector.

I, myself am utterly addicted to my Hydroflask which has legit kept ice in my water for over 24 hours at a time. I try to get through 2 of the 32 ouncers daily.

Above all, look for and AVOID plastics with recycling codes 3 (phthalates), 6 (styrene), and 7 (bisphenols) unless they are labeled as “biobased” or “greenware.”

Wash it up

  1. Clean all fruits and vegetables that cannot be peeled. At a minimum, ALWAYS rinse thoroughly with clean water. To be more thorough, you can buy special organic fruit and veggie wash or make your own:
    • 1 tablespoon lemon juice
      2 tablespoons distilled white vinegar
      1 cup cold tap water
  2. Wash hands thoroughly with soap and water before and after touching said food

Honesty Time

Maybe you have already done all of this and your child has never had plastic touch their precious lips. If so, that is awesome and you should for real pat yourself on the back! These changes are also WAYYYYY better for the Earth so, double win!

Guess when I changed over from microwaving my kids’ milk in their plastic sippie cups? Last night when I sat down and read this statement for myself. Cue #momguilt explosion.

Motherhood and life in general is a learning process. Let’s keep updating ourselves and do the best we can. And if you’re like me and just now realized that “hippie friend” was right about all this? The chance you’ve inflicted any permanent damage on your kid is low. Do what you can, take a deep breath and give yourself some grace.

xoxo, Dr. Annie

Pregnant, MD: What’s Safe in Pregnancy Myth vs Fact, Part 1

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Photo Credit: Fiona Margo Photography

Hey mamas and mamas-to-be! There is a lot of confusing and alarmist information out there on the interwebs about the safety of lots of things everything in pregnancy. We all want to be safe, but also to not be deprived of allofthethings for 9+ months. This post is a quickie guide to set the record straight on some of the most common questions we pregnancy providers get. This, like all my posts, are not ever meant to replace the personal guidance of your own health care provider – when in doubt, as them! I’m breaking this down on the following very non-scientific scale:

Myth – Mostly Myth – Kind of Fact – Mostly Fact- Fact

No Coffee – Myth

Our family lived in Portugal when I was in Kindergarten and first grade, so that was about the time I started drinking coffee. No joke. So, when I was learning about pregnancy, you better believe I looked up all the information on this topic! I can’t tell you how many people I have talked to – even other doctors – who are under the impression people have to stop drinking all caffeine the moment they conceive. That’s just cruel.

My actual face if you told me not to drink coffee while pregnant.

The truth is, The Cochrane Review looked at the research and the best studies have shown no difference in pregnancy outcomes with moderate caffeine intake. What’s “moderate caffeine intake”? About 200mg caffeine daily. That’s one tall Starbucks brewed coffee or an espresso drink with 2 shots. Strong black tea has about 50mg per cup and regular or diet soda (bad for other reasons….but) about 35mg. Energy drinks vary widely – if you want to look up your specific fave bev, check out Caffeine Informer.

No Hot Tubs – Mostly Fact

This one is legit. Studies have shown that raising your core body temperature can increase the risk of miscarriage in early pregnancy and other complications later on in pregnancy. This is true whether it’s a high fever from being sick or you are in a hot tub, sauna, hot yoga, or even hot bath or shower at home.

Does this mean you can’t take a quick hot shower ever? No! You can go in any of these warm environments for a little while. What’s a little while? As soon as you feel hot, break a sweat, or of course if you feel light headed at all, leave and cool off immediately. If you can’t trust yourself to make that judgement, avoid altogether.

No Hair Treatment – Mostly Myth

The old types of hair treatments for dying and perming had toxic chemical derivatives which were potentially dangerous, especially in first trimester of pregnancy.

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Definitely got my hair did before these pics.

Newer dyes should be free of these chemicals and are ok. Highlights that aren’t applied to your scalp are also fine – just stay in a well-ventilated area because your breathing can be more sensitive during pregnancy. Perms and straightening treatments again vary – ask your salon if they offer safe, natural alternatives to the older more harsh treatments. More info HERE on American Pregnancy’s Website.

No Nail Polish – Mostly Myth

You can get your nails did with no worries as long as the salon uses good hygiene practices. One of my favorite midwives from my training at UCSF, Judith Bishop, wrote a great summary HERE on this. Any kind of polish and even fake nails are ok. Beware though – the chemical smells might make your sensitive nose and stomach unhappy!

No Cheese – Mostly Myth

The key here is *pasteurized*. You can get Listeria, a dangerous bacterial infection that can cause miscarriage, from unpasteurized dairy products. Pasteurized cheeses that are within their expiration dates and have been properly stored are fine. Even soft cheeses. Most restaurants should be able to tell you if their cheese is “raw” or pasteurized – if they can’t skip it.

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No Lunchmeat – Kind of Fact

This again is due to Listeria concern. You should avoid lunch meat unless it’s been heating to steaming in the microwave, stovetop or oven. Not sure how you feel about warm lunchmeat, but this preggo is NOT for it! Opt for grilled chicken, tuna salad (no more than 2 servings per week though) or other choice if you don’t like warm sliced meat.

 

No Fish – Kind of Fact

Speaking of tuna…. The main concern with seafood is about mercury. Check out and print yourself THIS PDF from American Pregnancy if you want a quick guide to which fish are “highest mercury” aka, avoid entirely or just “high mercury” aka have no more than 2 small servings weekly or lower and you can enjoy at will.

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Photo by Skitterphoto on Pexels.com

What about sushi?? So, cooked sushi is always ok as long as you are paying attention to mercury issues. Raw sushi *theoretically* should all be flash frozen based on USDA safety regulations and therefore should NOT have the parasites that are of concern in pregnancy. However, you are putting your trust in the sushi fish purchaser and preparer in this care, so approach with caution.

 

 

 

 

No Strenuous Exercise – Mostly Myth

There are no strict guidelines regarding exercise in pregnancy because this is highly variable as to what is safe and normal for YOU. There are elite athletes who’s “norm” is to run 10 miles or lift hundreds of pounds of weights on the regular. There are couch potatoes who get winded walking up a single flight of stairs.

Seriously, though… Exercising in pregnancy is actually key to having a healthy pregnancy, easier delivery, and – get this – fewer stretch marks! The main guide here is how the exercise makes YOU feel. Yes, that’s right, you have to listen to your body. This is not the time to “push through” and override your body telling you it is hot, too winded or  overworked. You will need to be more cautious with yourself because your blood flow is altered, your body shape is changing and your muscles, ligaments and tendons will be affected by relaxin hormone eventually.

No Sex – Mostly Myth

OK, think about it. If having sex while pregnant was dangerous, do you really think humans would have survived this long? A lot of pregnant woman have their libido skyrocket thanks to increased blood flow to the lady parts (though if you don’t that’s nothing to worry about). It is ok and GOOD to have sex if you want to in pregnancy. Get. It. On.

A few words of caution though… If you have pain or bleeding during sex, stop. Have your doctor check you and tell you if it’s safe to continue having intercourse during your pregnancy. And if you’re pregnant and single – you need to be ultra careful about not contracting an STD. They can cause severe birth defects, miscarriage or stillbirth if contracted while you are gestating. Safe sex – good. Unsafe sex – bad.

No Smoking – Fact

This includes ALL smoking. Smoking cigarettes and being exposed to second-hand or even third-hand (if you smell it even though no smoke is around, that’s third-hand smoke) can cause complications in pregnancy. If you are smoking when you conceive, talk to your provider right away about how they can help you quit. If people around you are smokers, same goes. It is NOT sufficient for them to just go outside. If your sensitive sniffer can smell the smoke, you’re being exposed. 

What about pot? It’s legal now and stuff, and doesn’t it help with appetite? NO, not safe in pregnancy. Marijuana has been shown to increase rates of ADHD, anxiety and other cognitive disorders in children who were exposed in utero. Stay away.

No Alcohol – Mostly Fact

Saved the most controversial for last! So, here in the USA, all of the official guidelines from the American College of Obstetricians and Gynecologists, the American Academy of Family Physicians, the American Academy of Pediatrics, etc… go along these lines, “There is no amount of alcohol known to be safe in pregnancy”. So, pregnancy providers will tell you to abstain completely from the time of ovulation if you might conceive through birth.

The Royal College of OBGYNs (Britain’s version of ACOG) takes a slightly more relaxed tone, saying “The safest approach is not to drink alcohol at all if you are pregnant, if you think you could become pregnant or if you are breastfeeding. Although the risk of harm to the baby is low with small amounts of alcohol before becoming
aware of the pregnancy, there is no ‘safe’ level of alcohol to drink when you are pregnant”. None of the large studies done recently showed negative effects on the baby or child with having a few drinks per week. However, the risk of preterm birth with alcohol exposure and of the devastating fetal alcohol syndrome makes pregnancy providers approach this with significant caution.

I know you are looking for a straight forward “yes you can have a glass of wine now and then” or “no, alcohol is truly dangerous”. We don’t have that yet. As a health provider, I follow the lines of saying, no amount is safe. As a woman physician, I know a whole lot of doctors who have read the studies and comfortably go ahead and have a drink now and then in the later parts of pregnancy. Ultimately, you’re in charge of making that decision for yourself and your unborn. Think about whether the anxiety when your kid seems hyper at age 3 that maybe they have subtle effects because you had a glass of wine at that dinner party is manageable vs the benefit you’ll really get from said glass of wine. You should for SURE never get drunk or even tipsy – that’s a no-brainer.

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Photo Credit: Fiona Margo Photography

What else?

This is why I called this Part 1… Please, comment away with questions, Myths you want busted, funny examples of crap your mother in law told you was unsafe in pregnancy! Part 2 will be based on your input. Whatcha wanna know??

Dr. Annie is a married mom of 2 with 1 more on the way (bump captured by Fiona Margo in the above pics, if you’re in the PNW look her up!!) and family physician in California.

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.

Image result for i'm sorry for the things i said when i was pregnant

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: 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: 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: 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:

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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

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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.

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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

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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

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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!!!