Tag Archives: pregnancy

Delivering Positive Experiences – Birth Plan Options for Expecting Moms

Settling on the right OB and birth plan are very personal choices for expecting mamas. However, it is important to know the facts and learn about each option before creating the right birth plan for you. One key decision of your plan is how you will labor. The board certified obstetricians at Medical Associates have summarized several of the main options and facts below to help you make this decision.

Laboring in an upright position has many benefits. Whether it be standing, leaning forward with your hands on your knees, sitting, or squatting, many women find gravity to be a natural helper during labor. When you’re lying down, the brunt of the weight and force is going against gravity. Being upright or leaning forward allows your contractions to work in a more efficient manner, working with your body, not against it. Your blood flow (the baby’s oxygen supply) is less likely to be compressed while upright, and it helps to open up your pelvis as well. Movement such as swaying, walking, and even dancing can help reduce discomfort, as well as help move your baby into the optimal position to navigate the birth canal.

Another popular method is laboring in warm water. Our obstetricians encourage any expecting mom to labor in the tub if they wish. There is evidence that laboring in a tub can be a successful method of pain management for women, and it may even shorten labor for some. This is because immersion in warm water promotes increased blood flow back to the heart and fluid movement within the body which reduces swelling. Advocates say it also helps to relax laboring moms by reducing their stress.

However, once it’s time to deliver that baby, we believe it’s also time to get out of the tub. On the topic of water births, Medical Associates follows the recommendations of the American College of Obstetricians and Gynecologists (ACOG). They advise that “given the facts and case reports of rare but serious effects in the newborn, the practice of immersion in the second stage of labor (underwater delivery)”2 is not recommended. The American Academy of Pediatrics (AAP) have also agreed with this recommendation.

There will come a time when you need to lie down for a break or for other health reasons. While lying down, there is another birthing tool that can help with your labor’s progression. It’s called a peanut ball and it’s a new option to moms delivering at Mercy Medical Center – Dubuque. Mercy offers the first and only certified ambassador for the peanut ball in Iowa. The peanut ball is an exercise or therapy ball that is shaped like a peanut and can be used in a variety of labor positions:

  • With mom in a semi-reclined position, one leg is placed to the side of the ball, and the other leg over it. A nurse then pushes the ball as close to the mother’s hips as is tolerable to her. This position promotes dilation and descent with a well-positioned baby.
  • If mom is in a side-lying or semi-prone position, the peanut ball can be used to lift the upper leg and open the pelvic outlet. This position helps rotate a baby in a less-favorable posterior position to a more favorable position for delivery.

The use of the peanut ball helps with the descent of your baby in your pelvis. Utilizing this birthing tool has even proven to help reduce the need for an emergency C-section.

At Medical Associates, we take the care of mom and baby very seriously while also being supportive of your wishes. What you will find most helpful during labor will depend on many things. And even the most perfectly prepared birth plan can also change in an instant. Knowing your options and preparing different techniques before birth can help your labor to progress more smoothly.

To help you formulate your birth plan and communicate your needs and wishes to your obstetrician, please utilize this Birth Plan Worksheet offered by Mercy Medical Center in Dubuque.

 

The Department of Obstetrics/Gynecology & Infertility provides complete obstetrical and gynecological care. Specialized services offered by our board certified physicians include: diagnosis and treatment of diseases, problems, or pathology affecting the female reproductive system. Professional infertility services include routine evaluation of infertile couples, diagnosis of infertility problems and treatment such as induction of ovulation and artificial insemination. Call 563-584-4435 to schedule an appointment.

 

Sources:
1. http://pediatrics.aappublications.org/content/133/4/758
2. https://www.acog.org/About-ACOG/News-Room/News-Releases/2016/ObGyns-Weigh-In-Laboring-in-Water-is-OK-but-Deliver-Baby-on-Land

Pelvic Health During Pregnancy and Postpartum

A woman’s body goes through significant changes during pregnancy and the postpartum period to prepare the body for development, growth, labor, and delivery of the baby. Many women experience pain, discomfort, difficulty with previously easy activities, or urinary leakage. It’s easy to brush these symptoms off, thinking they will improve shortly after the baby arrives, but that isn’t always the case. Whether you are currently expecting, a new mom, or a seasoned veteran, pelvic floor physical therapy could help – especially if the pain, incontinence, or discomfort lasts longer than three months postpartum. It is optimal to begin pelvic floor physical therapy at the start of your pain instead of waiting to see if it improves. This decreases the risk of further injury or worsening pain during pregnancy or postpartum.

Over the course of your pregnancy, pain can come from a variety of sources. Relaxin, a hormone that causes ligaments to become more relaxed, causes a change in the center of gravity as the uterus grows. Carrying a progressively larger load around with each activity changes how the body moves, predisposing pregnant women to pain or subsequent injury. This pain can be felt in the low back, pelvic girdle, and hips, but also in the neck, shoulders, and upper back.

With pelvic floor physical therapy, your therapist can assess the strength and function of your pelvic floor muscles and inner core. You can learn how to carry grocery bags, pick up your other children, clean the house, perform your work tasks, and anything else you need to do but in a way that decreases the strain to your pelvic floor, back, and core. Physical therapy can help improve your strength and your therapist can help you find ways to exercise that are gentle, beneficial, and individualized to your needs.

Another common pregnancy issue is urinary incontinence. During delivery, your pelvic floor muscles endure a great deal of stress and they must stretch to allow for the baby to pass and then adjust as the load they were just helping to support is now gone. If you experience leakage that lasts longer than four weeks postpartum – pelvic floor physical therapy can help; even if you delivered many years ago. Continence can be maintained during pregnancy and postpartum with the right training program and learning how to move optimally.

Pelvic floor physical therapists are equipped to assess the pelvic floor after delivery. An assessment of strength, endurance, coordination, tension, episiotomy scars, C-section scars, and/or a separation to the abdominal muscles can all be beneficial during the postpartum healing process. This is true even if you are feeling well and not experiencing pain, leakage, or did not have an episiotomy, C-section, or tearing. Interventions are available that allow the healing process to be better supported and more complete without developing other habits or strategies for movement that are less than optimal.

If you are pregnant, newly postpartum, or know someone who is, ask about pelvic floor physical therapy. Rest assured your therapist should work closely with your OB-GYN to understand any precautions or contraindications that are important to your care. Call 563.584.4465 to schedule an appointment or submit an electronic inquiry by following this link.

Gosse_B_2017_ultiproBrittany Gosse, DPT
Department of Physical Therapy
Medical Associates Clinic

 

 

 

Your Health is Important When Trying to Conceive

Every aspect of your health – from the drinks you consume to the exercise you do (or don’t do) – can have an impact on your fertility and on the health of your pregnancy. By looking at your healthy (and unhealthy) habits now (before the bun is in the oven) you can start off on the right foot. Our expert OB/GYN team has shared some important steps to take to ensure your health is at its best for conception, which will hopefully make conception easier and your pregnancy safer.

Habits to Break

Smoking is never good for you, so just don’t do it. But if you need a little motivation not to light up, repeat this fact to yourself: smoking (cigarettes, e-cigarettes, hookahs, vape pens, and so on) causes my 30-year-old eggs to act more like 40-year-old eggs. This results in a more difficult path to conception and a greater risk of miscarriage. Heavy smoking damages the ovaries as well as the uterus, and secondhand smoke can harm your health and fertility, too, so just choose to stay away!

Along with smoking cigarettes, smoking marijuana isn’t good for conception either. Whether you smoke, vape, or consume edibles, you can inadvertently affect the ability of your partner’s sperm to fertilize an egg – even if he doesn’t smoke marijuana! The active ingredient in marijuana, THC, gets in your vaginal fluids and reproductive organs. So to be most fertile (not to mention safe), say goodbye to marijuana. (And you should obviously also not use any illicit drugs, including cocaine, crack, or heroin, etc.).

Some studies have linked too much caffeine consumption with lowered fertility and an increased risk of miscarriage. If a baby is in your immediate plans, it’s time to put a little less coffee in your cup. You don’t have to give it up completely but moderation is the key here. Limit your caffeine intake to no more than 200 mg per day. That’s equivalent to 12 ounces of brewed coffee per day.

Another beverage to limit (or eliminate completely) is alcohol. Drinking alcoholic beverages in excess can mess with your menstrual cycle, possibly interfering with ovulation. And because you won’t necessarily know the moment you conceive, there’s a chance you might be drinking in the first few weeks of your baby’s growth. Drinking alcohol while pregnant could harm your little one in the future. Choose to reduce your drinking to less than 7 drinks a week and never more than one on any occasion when trying to get pregnant. Only you and your bartender need to know you’re drinking a mocktail.

As far as medications go, most over-the-counter and many prescription meds are considered safe while you’re trying to conceive. But because some medications may compromise fertility, you should run any medications you take by your provider before you consume them. This includes the medications you take for your chronic condition and any vitamins or herbals you may take on a regular basis. The good news is there are almost always safer alternatives. Just ask your healthcare provider before making any changes to your medication routine.

Habits to Keep

There is a strong connection between weight and fertility. Reaching a healthy weight for your body type is an important step for conception. It’s not just the scale that determines this, though. The relationship between your weight and height are factored to determine your body mass index, or BMI. Being overweight can cause diminished egg quality, decreased ovarian function, or polycystic ovarian syndrome (PCOS), a fairly common cause of fertility issues. Alternatively, women with a low BMI can also experience conception woes. Being underweight can lower estrogen levels, which can lead to irregular ovulation or periods (or even no ovulation or periods). Women who are obese or underweight when they become pregnant also have a higher risk of miscarriage.

Though it may be different for everyone, a moderate exercise program is the key. Moderate exercise can boost fertility, and you only need 30 minutes of aerobic exercise to do this. It can be walking, stretching, strength training, or anything that increases your heart rate. Remember to keep an eye on your body fat though. Prolonged, strenuous exercise can disrupt the delicate balance of hormones needed for ovulation and conception, especially if your BMI is very low. An ideal BMI for conceiving is between 18.5 and 24.9.

Before you put yourself on a diet or start packing on the carbs, it’s important to talk to your healthcare provider. Come up with a simple plan that features a well-balanced diet. Fill your meals with lean protein, veggies and fruits, and low-fat dairy. Cut down on junk foods and sugary drinks. Try water instead. Add in that moderate workout routine discussed above and you’ll be ready to kick-off your healthy path to pregnancy!

A good night’s rest is also very important. Six to nine hours of sleep per night is best. Beating the stress of the day and letting your body recuperate will only encourage fertility.

Finally, take 400 to 800 micrograms (400 to 800 mcg or 0.4 to 0.8 mg) of folic acid every day if you are planning a pregnancy or are currently pregnant. You can take a vitamin or eat a breakfast cereal containing your daily quota of folic acid. This will lower your risk of some birth defects of the brain and spine, including Spina bifida. Talk with your doctor about your folic acid needs. Some doctors prescribe prenatal vitamins that contain higher amounts of folic acid.

 

Whether it’s your first, second, or fifth baby, your body needs to be nurtured and cared for so that it can do the same for your future child. Both the female AND the male partner’s fertility can benefit from the advice listed above. And remember that no two bodies are exactly the same, so talk to your doctor before getting pregnant. They will discuss your medical history, any medical conditions you have, any medications you are currently taking, and any vaccinations you might need. This will help make a preconception health plan that is best for you.

For more information on preconception health, check out this conception plan template from the CDC.

 

The Obstetrics/Gynecology & Infertility Team at Medical Associates Clinic:
Joseph Berger, MD  |  Tara L. Holste, DO  |  Lisa A. Kramer, MD
Trupti S. Mehta, MD  |  Laura Neal, MD  |  Erika O’Donnell, MD

Call 563-584-4435 to schedule an appointment.

 

ZIKA VIRUS: The Basics of the Virus and how to Protect Against It

Zika, a mosquito-borne virus, emerged on the world stage in February when the World Health Organization declared Zika virus a Public Health Emergency of International Concern (PHEIC). Since then Zika has been quite popular in the news. Medical Associates wanted to take the time to review some key information regarding Zika and how to prevent infection:

Zika virus spreads to people primarily through the bite of an infected Aedes species mosquito. There is no vaccine to prevent Zika virus disease. The current outbreak is spreading through Central America and parts of South America, but the virus was actually first discovered in 1947 and is named after the Zika Forest in Uganda. In 1952, the first human cases of Zika were detected and since then, outbreaks of Zika have primarily been reported in tropical Africa, Southeast Asia, and the Pacific Islands.

How Zika Spreads

The mosquitoes that carry Zika are aggressive daytime biters, but they can also bite at night. A mosquito becomes infected when it bites a person already infected with Zika. That mosquito can then spread the virus by biting more people. Zika virus can also spread:

  • During sex with a man infected with Zika.
  • From a pregnant woman to her fetus during pregnancy or around the time of birth.
  • Through blood transfusion (likely but not confirmed).

Zika Symptoms

Many people infected with Zika won’t have symptoms or will only have mild symptoms. The most common symptoms are fever, rash, joint pain, or red eyes. Other common symptoms include muscle pain and headache. Symptoms can last for several days to a week. People usually don’t get sick enough to go to the hospital, and they very rarely die of Zika. Once a person has been infected with Zika, they are likely to be protected from future infections.

However the Centers for Disease and Prevention (CDC) warn that the Zika virus is a serious threat to pregnant women as a mother can pass the virus to her fetus. This infection can cause the baby to suffer a serious birth defect of the brain called microcephaly. Other problems have also been detected among fetuses and infants infected with the Zika virus, such as defects of the eye, hearing deficits, and impaired growth. There have also been increased reports of Guillain-Barré syndrome, an uncommon sickness of the nervous system, in areas affected by Zika.

How to Prevent Zika

The best way to prevent diseases spread by mosquitoes is to protect yourself and your family from mosquito bites. Here’s how:

  • Wear long-sleeved shirts and long pants.
  • Stay in places with air conditioning and window and door screens to keep mosquitoes outside.
  • Take steps to control mosquitoes inside and outside your home.
  • Treat your clothing and gear with permethrin or buy pre-treated items.
  • Use Environmental Protection Agency (EPA) registered insect repellents. Always follow the product label instructions. When used as directed, these repellents are proven safe and effective even for pregnant and breastfeeding women.
  • Do not use insect repellents on babies younger than 2 months old.
  • Do not use products containing oil of lemon eucalyptus or para-menthane-diol on children younger than 3 years old.
  • Mosquito netting can be used to cover babies younger than 2 months old in carriers, strollers, or cribs to protect them from mosquito bites.
  • Sleep under a mosquito bed net if air conditioned or screened rooms are not available or if sleeping outdoors.
  • Prevent sexual transmission of Zika by using condoms or not having sex.
  • If traveling, please visit the CDC Travelers’ Health site for the most updated travel information.
  • Specific areas where Zika is spreading are often difficult to determine and are likely to change over time.

Source: www.cdc.gov/zika

The Medical Associates Department of Internal Medicine provides an internist who subspecializes in Infectious Diseases (“ID”). This field of medicine deals with infections caused by bacteria, viruses, and other microorganisms including fungi, parasites, and mycobacteria (the organisms which cause the many forms of tuberculosis, HIV, and hepatitis). The ID physician provides diagnostic and therapeutic services, including guiding the administration of complicated antibiotic regimens. In addition, advice regarding travel and immunizations (including yellow fever) are available for those patients planning trips outside of the United States. Visit our website or call 563-584-3430 for more information.

Dr. CaceresHonorio J. Caceres, MD has been practicing at Medical Associates since 2003. Board certified in Internal Medicine and Infectious Diseases, Dr. Caceres received his Doctor of Medicine degree from Frederico Villarreal University in Lima, Peru.