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: A Parent’s Intuition

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

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

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

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

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

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

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

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

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

Dr. Annie Answers: Getting Pregnant

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: Kid Vitamin Basics

Mother’s Day is this weekend which has me thinking about all the things moms have to worry about… one of the most common being the nutrition and health of our precious little ones. Almost every day at my clinic, I get some sort of question about vitamins – What’s safe? What’s necessary? Where do I get good ones? The answer, of course, varies by your particular health needs and should be discussed with your own medical provider. A few things are pretty generalizable though and I’ll delve into them here by age. This post is about kiddos – coming up next will be an adult version, so make sure you FOLLOW US to get that update!

Breastfed Babies, Birth through 12 months: 400 units Vitamin DScreen Shot 2018-03-09 at 2.08.17 PM

Vitamin D is needed for all babies who are breastfed half or more of their milk intake. I nearly always recommend Baby Ddrops for those who can afford the $10/month averaged cost. These are concentrated drops so, instead of getting your tiny baby to choke down a whole milliliter of vitamin D like the generic ones at the pharmacy, you only have to put 1 drop on your clean finger and put on baby’s tongue before a feeding. If your baby is formula fed, no vitamins needed, they’re already in there – see below for details.

Breastfed Babies, 4 months through 12 months: Add 6-11mg Iron

Iron is recommended for breast-fed babies after the first 3 months of life. Mom’s iron from the womb keeps them going up until that 4 month mark.

Sidenote…. One of the potential benefits of delayed cord clamping at birth is increasing baby’s iron stores for that first 3-4 month period (great review on this by Dr. Raju et al here.) . This is, of course, an important thing to discuss with your own pregnancy care provider, but worth considering for this and other benefits if there is no reason not to do it.

From ~4 months through the rest of the first year, baby will start eating more and more ‘real’ foods which can supply some iron, but usually not enough. The recommended amount by the American Academy of Pediatrics for babies 7-12 months is 11mg per day. For reference, you’d have to get your baby to eat 2 cups of cooked spinach to get that much – not gonna happen.

Option 1: at this age, stop Vitamin D supplement and change to multivitamin. Poly-vi-sol with iron is the go-to recommendation for most health care providers. However, my daughters both projectile vomited it, so we had to use alternatives. Other options are Zarbees Baby Multivitamin with Iron  and Honest Company makes an easy-to-give vitamin powder: Link herepexels-photo-533360.jpeg

Option 2: continue with Ddrops and give iron-only supplement like this one or give a serving of iron-enriched cereal daily. I personally, along with a growing number of pediatric care providers, recommend the former along with introducing iron-rich foods such as pureed meats, dark leafy vegetables, beets and beans before cereals as part of a healthier early diet. Baby cereals don’t otherwise have much in the way of nutrition or “taste education” for that little one. (References here in AAP News and here from NIH)

Formula-fed Babies up to 1 year

Breast-milk is best for moms and babies that can do it in all aspects except these 2 vitamins. Formula comes conveniently stocked with both Vitamin D and Iron so you don’t have to worry about the supplements. Certainly not a reason to choose it over breastmilk, but a nice side-benefit if it ends up being the right option for you. I usually recommend Baby’s Only Organic Formula or Plum Organics Grow Well Formula. Screen Shot 2018-05-07 at 5.58.09 PMThey are well tolerated (review here), have the right amount of all important nutrients and both come out to roughly $1/ounce (compare to Similac Advance Non-GMO at $1.25/ounce). They are also organic and free of corn syrup solids and chemical additives – which, when you’re talking about the ENTIRE nutrition of your tiny rapidly growing baby is important. AND!! You can get them both on auto-ship from Amazon so no leaving the house – bonus!

After 1 year: Vitamin D 400-1000 Units Daily +/- others…pexels-photo-61129.jpeg

This now depends on how picky of an eater your kid has become. If you have that amazing, adventurous eater who loves a variety of meats, fruits, and vegetables and drinks 2+ cups of milk per day, multivitamins are unnecessary. If your child doesn’t get 400-1000 units Vitamin D from fortified milk and other foods, they will need a vitamin D supplement again. Why? What about kids before the advent of vitamins?? Well, kids were outside ALL DAY without sunscreen back then. We now know better and protect their skin – the downside of which is low vitamin D.

If you do have a picky eater  – even if you’re not sure how picky is picky – a multivitamin can fill in the gaps. Again, the above mentioned Zarbee’s and Honest options are great as is Renzo’s Picky Eater Multi. If they’re getting extra of some of those vitamins, they will pee them out.

Hang on…. I hear a question coming out of the Ether….

“Dr. Annie, are the examples you listed above the only good options?? What about Flintstone’s vitamins or Olli Chewables?” Of course those aren’t the only vitamin brand options. If you want to check out others, just read the fine print on the label on the back and make sure they have the right amounts of the recommended vitamins.

Wait…. another one coming in…. “What about probiotics??” I’m so glad you asked! YES probiotics are so important from infancy through the rest of life – so important I’m going to write a separate post all about it ;^)

94 Dr. Annie is a family physician, wife and mom of 2 picky eaters In the Sacramento Area.

Dr. Annie Answers: Open Letter to my Patients

Dear patients,

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

Things you don’t need to apologize for

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

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

 

Exercise and diet

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

A picture is worth 1000 words

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

Agenda-setting

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

Share, learn, love.

-Dr. Annie

pexels-photo-433267.jpeg

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!!!

Dr. Annie Answers: Sunscreen Low Down

Anyone else feel utterly overwhelmed by THIS when you hit the stores lately? The choices are ENDLESS!!

Whether you’re still in flurries or the sun is shining, summer is coming! You all know by now that sunscreen is absolutely critical for you and your fam to prevent deadly skin cancer (if not, what rock have you been living under, seriously??). The huge array of options can be super overwhelming.

I’m going to try to simplify things here. There are 3 rules:

  1. Choose physical over chemical sunscreens.
  2. Choose creams/lotions over sprays.
  3. If your choices are limited, still choose some sunscreen over no sunscreen.

In slightly more detail….

Physical vs Chemical

There are 2 ways to block the sun’s damaging rays. One is physical blocking. This includes simple shade or clothing or reflective minerals that you put on your skin. The two primary ones are Zinc Oxide or Titanium Dioxide. The other way to decrease UV radiation is with chemical sunscreens. These are ingredients like Avobenzone, Oxybenzone, Dioxybenzone. Yes, these block UV rays. However, they have not been studied well in humans and in animal models, can be absorbed through the skin – aka, get into the bloodstream and cause problems with endocrine function (thyroid regulation, hormone regulation, blood sugar regulation). Gross.

There is an awesome guide for brand-to-brand ratings here EWG’s Guide to Sunscreens. Our family’s go-to’s are:

Screen Shot 2018-04-10 at 10.10.07 AMBare Republic Mineral Sunscreen

Easy to find at Target and Amazon, goes on nicely, badass bottle (I’m a sucker for good marketing). Sport and Baby versions available. Stick version convenient for little faces.

 

 

Screen Shot 2018-04-10 at 10.12.15 AMCalifornia Baby Super Sensitive Sunscreen

No, I don’t just love this because it says “California Baby” (ok maybe a little), it’s also ultra-sensitive for the rashiest kids. Again, stick version available.

 

 

 

Screen Shot 2018-04-10 at 10.18.57 AM

Blue Lizard Australian Sunscreen because you know the Aussie’s got the sunscreen game DOWN. This goes on easily – not just for babies ;^)

 

Arbonne Baby Care Mineral Sunscreen Screen Shot 2018-04-10 at 10.49.35 AM

 

 

 

 

Arbonne is sold directly through independent providers – I get my goods from my awesome niece (she’s an adult, we have a crazy big family) Megan Fikes

 

 

 

Screen Shot 2018-04-10 at 10.13.57 AM

Elta MD UV Clear Tinted This is the only sunscreen that has EVER not made my face allergic, and with slightly tinted look, is flattering and not white. I wear this every. single. day.

 

 

 

 

 

I can hear you now:  But lotion is so hard to get on a whining, wiggling kiddddd!!! 

Strategy: Before you even get dressed to go wherever fun, sunny place you’re going, apply to your naked child. This way you have a “base layer” in case of wedgies or – if your kids are like mine – unexplained nakedness. Then, just touch up when the clothes come off. Reapply (of course) every 2 hours or when they get out of a body of water and defrost/dry off for a bit.

Spray vs Lotion

When you, as an adult, put on that super-convenient aerosol-spray clear chemical sunscreen, have you ever gotten a *little* of the spray up your nose at the end? And you know how to hold your breath well. Game over for kids – they’re for sure getting it in their nose, eyes, mouth… lungs, stomach. I’m a laid-back parent about dirt, mess, hair dye, the occasional junk-food treat. But chemicals being inhaled and swallowed?? nope.

That being said… there are times and particular children that do require faster application. So IF you must use a spray, top choice is a manual spray bottle with mineral sunscreen, because, the environment. Choice 2 is aerosol mineral sunscreen. Really, just avoid the chemical ones unless it is literally the ONLY way to not have a severely sunburned child.

Kiss My Face SPF 50 SprayAlba Botanical Refreshing Spray Mineral SunscreenBare Republic Spray

Final Rule: Some protection is better than nothing.

Questions come up in clinic all the time about “how old does my baby have to be to wear sunscreen?”. The best, safest sun protection for babies is to keep them in the shade. This goes for all ages, actually.  Avoid the strongest sun, wear hats and loose layers when you can, seek shade.

This is most applicable for babies that are non-mobile. That is the primary reason that the typical recommendation is to start sunscreen when your baby is 6 months old. That is when most babies start to crawl and shade is less reliable. That being said – if you’re gonna be at a sunny farmer’s market with your 4 month old baby in the Ergo, they might pull their perfect sun-protective hat off and yes, you should put a little swipe of safe, mineral sunscreen on their sweet face and hands and toes if they’re exposed.

And if you’re in a pinch, forgot alllll the sunscreen in the bag (maybe because someone left that bag in the entryway when the kids were being loaded into the car…), and the only sunscreen available is some aerosol Coppertone at the gas-station. Yes. Use the sunscreen. Life is all about minimizing risk and doing the best we can.

IMG_2947

Dr. Annie is a married mom of 2, family doctor, amateur blogger and Nerium international independent brand partner. This post is her own opinion, is not sponsored by any products listed and does not replace the personal advice of your own physician.