| Ask the Expert Archive |
|
Ask the Expert is not a substitute for professional medical advice, diagnosis or treatment. Never delay or disregard seeking professional medical advice from your physician or other qualified health provider because of something you have read here. Preconception
Preconception |
|||||||||||||
| Ethnicity | CF Carrier Rate in People with No Family History of CF |
| Caucasian | 1 in 25 individuals |
| Ashkenazi Jewish | 1 in 26 |
| Hispanic | 1 in 46 |
| African American | 1 in 65 |
| Asian | 1 in 90 |
— Elissa Morris, M.S., CGC, Board Certified Genetic Counselor, Southwest Washington Medical Center
Q: Our first child was born with a genetic birth defect. We would love to have more children, but we are concerned about having another child with special needs.
— Elissa Morris, M.S., CGC, Board Certified Genetic Counselor, Southwest Washington Medical Center
Q: I’ve heard a lot about testing for Down syndrome. Nobody in my family has Down syndrome. Why am I being offered testing?
— Elissa Morris, M.S., CGC, Board Certified Genetic Counselor, Southwest Washington Medical Center
Q: How soon after stopping birth control can I get pregnant?
— Margaret Griffith, MD, The Woman’s Clinic of Vancouver
Q: How can I identify my most fertile days?
A: Each woman’s menstrual cycle is different. In order to determine your fertile days with accuracy it is first important to determine whether your menstrual cycles are normal. Take notice of certain physical and emotional symptoms (premenstrual symptoms) that occur just prior to your period, and usually subside several days into your period. These symptoms include breast tenderness, bloating, cramping, and mood changes (irritability, anxiousness). The presence of these symptoms usually indicate that you have ovulatory cycles, which means you are ovulating normally. Another important finding you can get from your menstrual calendar is your cycle length. Average cycle lengths are 28-30 days. Cycles less than 21 days or greater than 35 days are not normal and require further evaluation as these are probably anovulatory cycles (meaning, you are not ovulating). Once you have determined whether you have ovulatory cycles, you can then perform easy tests to best determine your fertile days.
The body undergoes a tremendous surge in the reproductive hormone LH, known as the LH surge. This increased hormone level is required to induce ovulation. This surge occurs approximately 12 hours to 1 day before ovulation. Your greatest chance (%) of achieving pregnancy is about 1 day before ovulation.
On average, your fertile days start approximately 14 days after your first day of your period. There are two additional tests that you can perform with little expense to identify your most fertile days: track your basal body temperature, and evaluate your cervical mucus. A more expensive, but more accurate determination of your fertile days would involve the use of LH surge kits available at most drug stores.
Basal body temperature involves tracking your temperature every morning, immediately upon awakening and before any activity. Purchasing "special" thermometers is unnecessary, though you want to use a thermometer that will distinguish a few degrees. Your temperature will rise approximately two days after your LH surge, or one day after ovulation. It is a retrospective view of determining when you ovulate therefore you must have absolute cycle regularity. Tracking your temperature over several months will give you an approximation of when the LH surge occurs, and therefore when you most likely ovulate. A small percentage of women will have monophasic graphs (meaning, no change in basal body temperature) during their ovulatory cycles. Scheduled intercourse should occur 3-4 days prior to and 2 days after ovulation. Keep in mind, scheduled intercourse should not occur more frequently than every 36-48 hours.
Your cervical mucus changes in quantity and character in response to your reproductive hormones. Your cervical mucus can easily be checked with your fingers after using the restroom. During your fertile days, the mucus is abundant, clear, and stretchy.
LH surge kits are urine tests that measure the LH urge. The test, like a pregnancy test, provides a qualitative + or – value. It is best to perform these tests with your first urination of the day. Remember, the LH surge usually occurs 12 hours to 1 day before ovulation. Therefore, scheduled intercourse should occur when the test becomes positive and over the next several days.
— James Carleo, MD, FACOG, The Woman’s Clinic of Vancouver
Q: What medical tests should I have before getting pregnant?
A: It is recommended to make an appointment with your medical provider prior to conception. Here, based on your medical history, habits and physical exam findings, your provider can order tests tailored to your specific needs. Several tests are commonly ordered and include a pap smear, rubella titers, complete blood count, chicken pox titers and hepatitis B status. An HIV screen, while optional, is also strongly encouraged.
— Michael S. Farber, MD, The Woman’s Clinic of Vancouver
Q: Is it safe to take megavitamins and herbal supplements while trying to conceive?
A: Megadoses of certain vitamins and minerals can hurt you and your developing baby. If you’re trying to get pregnant, your best bet is to eat a well-rounded diet and take a prenatal vitamin with folic acid every day. The prenatal vitamin should have at least 400 micrograms of folic acid and DHA, which is an omega 3 fatty acid. The folic acid can prevent some birth defects, and the DHA helps with brain and eye development.
— Allison Higgins, MD, The Woman’s Clinic of Vancouver
Q: I‘m 39. What risks are associated with getting pregnant at a later age?
Q: How long before becoming pregnant should a woman start preparing for pregnancy? What are the five most important things she should do before pregnancy for her and her baby’s health?
Q:Now that I’m pregnant, I expected it to be a happy time for me so why am I so depressed?
— Wendy Draper, MD, Vancouver Clinic
Q:The results from my maternal serum screen (Triple/Quad, First or Sequential Screen) came back abnormal/screen positive. Should we see a genetic counselor?
A: Absolutely. You are probably very concerned about the implications of the test. A genetic counselor can review the results with you that indicated an increased risk for one of a few conditions such as Down syndrome or Spina Bifida. These tests are screening tests, which means the results come back as a percent risk and depending on the percent, are put into either a high risk (screen positive) or low risk (screen negative) group. The test never comes back with a 100% risk, so keep in mind high risk doesn’t mean the baby has a condition, but that it is more likely to have a condition. When results come back as high or abnormal, you will be given the option to have a diagnostic test, such as an amniocentesis, which will give a yes/no answer if the baby has a condition such as Down syndrome. Thus, a genetic counselor will explain in detail how an amniocentesis works as well as the risks, benefits and limitations of such testing. Learn more about genetic counseling and prenatal testing >
— Elissa Morris, M.S., CGC, Board Certified Genetic Counselor
Q: How can I tell the difference between Braxton-Hicks and real contractions?
A: Braxton-Hicks contractions are quite common. You can follow these guidelines to help you determine if you should call your doctor:
The Real Thing (True Labor)
False Start (False Labor)
If you’re still unsure, call your physician or go to the hospital for guidance.
— Joe Chang, MD, The Women’s Clinic of Vancouver
Q: I’d like to try to have my baby drug-free. Is using acupuncture during labor an option at Southwest Washington Medical Center?
A: Having a baby without pain medicine is, of course, a choice any woman can make. If you are concerned about medicines hurting your baby, discuss your concerns with your doctor. Often you will find your concerns are not necessary. If you would simply like a more natural experience, that is certainly fine. Acupuncture is one of many alternative relaxation methods that include music, whirlpooling, and doulas. If you considering any of these techniques, discuss it with your doctor as soon as possible so you can be sure you are on the same page. We all want you to have a labor experience that is safe and consistent with your desires.
— Joe Chang, MD, The Women’s Clinic of Vancouver
Q: What is pre-eclampsia?
A: Pre-eclampsia is a form of high blood pressure brought on by pregnancy. It is also known as pregnancy-induced hypertension (PIH) or toxemia. Eclampsia is seizures or convulsions caused by a severe form of pre-eclampsia.
Because it causes your blood vessels to constrict, pre-eclampsia reduces the amount of oxygen and nutrients delivered to your baby and can lead to low birth weight. Left untreated, it can also cause your liver, lungs, and kidneys to fail. Despite intensive research, no one knows exactly what causes the condition, and it continues to affect roughly 7 out of 100 pregnant women, humans are the only species that are known to get this disease, so animal research has not been helpful. Learn more about pre-eclampsia >
— Joe Chang, MD, The Women’s Clinic of Vancouver
Q: I’ve heard of situations where the baby’s shoulders can get stuck in the birth canal. Can this be predicted before labor starts? How is it treated?
A: Shoulder dystocia—when the baby's head is delivered but the shoulders cannot progress because they’re too wide beyond the mother's pubic bone—is usually unpredictable and is first noticed during delivery. If your health care provider suspects that you are at risk for shoulder dystocia, he/she may recommend an ultrasound scan before you go into labor. The ultrasound scan can help determine how big the baby is and whether the baby's size might be a problem during delivery.
Should dystocia can be caused by:
Some techniques that might be used if shoulder dystocia occurs during labor include:
For more information, watch this informative video on C-sections.
— Joe Chang, MD, The Women’s Clinic of Vancouver
Q: If a pregnancy takes 40 weeks, why do they call it trimesters?
Q:How long into my pregnancy can I practice yoga?
Q:Is it ok to lie on my back to practice yoga when I am pregnant?
A: The answer to that varies. However, there is no medical proof that you cannot perform some supine yoga poses. We always encourage you to listen to your body, check with your physician and do what feels right. If something hurts or does not feel comfortable we have modifications that will support your body. A healthy pregnant woman can perform most any pose with the proper guidance from a certified yoga instructor. Prone positions, (on the belly) are modified with Cat/Cow, Spinal Balance and Kneeling Side Plank. Twists and inversions should be avoided during pregnancy. Be sure to attend a class that is taught by an instructor who is certified specifically in Prenatal Yoga.
Learn more about exercise during pregnancy >
— Dana Layon, E-RYT, Satsang Yoga, Vancouver, WA
Q:What choices do I have for pain control during labor and delivery?
A: An Epidural is a regional anesthetic technique in which an epidural needle is passed, between the vertebra of the spinal column, into the epidural space, just outside a membrane (dura), that surrounds the spinal cord, spinal nerve roots and the spinal fluid. A thin plastic tube (catheter) can be placed, through the epidural needle and the needle removed, to allow continuous infusion of anesthetic medication through the catheter. This can provide labor and delivery pain relief for long periods of time or can be intensified and used for cesarean section, if required.
A Spinal is performed when a thinner needle is advanced, a small way past the epidural space, and through this dural membrane, into the spinal fluid. Because the anesthetic medication is placed directly into the spinal fluid, less drug is required to produce an effect. Spinal doses, however, produce very intense numbness with loss of lower body movement and are usually reserved, in labor and delivery practice, for cesarean section.
An Intrathecal uses, basically, the same technique as a spinal but, with lower concentrations and amounts of anesthetic medications. This often provides quick pain relief, without undue numbness or loss of movement, and allows effective pushing with delivery. Because it is a one shot technique, however, it usually lasts for only 1-3 hours. This makes it most useful nearer the end of a rapidly moving labor.
A Combined Spinal/ Epidural (CSE) is another regional anesthetic technique, that would be better named Combined Intrathecal/ Epidural, because it truly combines those two techniques. Its main advantage is overcoming the time limits of the intrathecal technique alone. The epidural needle is positioned in the epidural space, a longer spinal needle is inserted through the epidural needle, the intrathecal dose is give, the spinal needle removed, an epidural catheter is threaded in and left in place as the epidural needle is removed. This allows a quick onset of pain relief, with the intrathecal dose, and a continuous infusion, via the epidural catheter, to provide pain relief for as long as it is needed.
Q: How painful is it to place an epidural/ spinal/ intrathecal/ combined spinal/epidural?
A: Many patients say that these regional techniques are no more uncomfortable than placing an (IV) intravenous line. Some say it is similar to having a tooth prepared with Novocain at the dentist. There is, routinely, a small pinch or sting as the local anesthetic is injected then, primarily, a feeling of dull pressure. Rarely, there may be a “funny bone” sensation (parasthesia), down the leg(s), as the needle or catheter is placed. Your anesthesia provider will make every effort to ensure your comfort during the procedure by providing verbal support, communicating each step of the process and appropriate use of local anesthetic. Each patient’s perception and pain threshold is different but, in general, these procedures are not painful.
Q:Can all patients in labor have an epidural and/or other regional techniques?
A: Not always. You may not be a candidate for an epidural or other regional anesthesia if you (a) are allergic to certain narcotics or local anesthetics, (b) have a nervous system (neurological) disease, (c) have a bleeding tendency or coagulation disorder, (d) take aspirin routinely,(e) have an infection in the lower back area, (f) have a psychological disorder or fear of needles that prohibits, (g) are morbidly obese, (h) have a spinal deformity, (i) are unable to cooperate by holding still and getting into proper position, (j) are too early in your labor, (k) are progressing too rapidly, or (l) have an abnormal labor or fetal monitoring pattern. Please discuss any potential problems, you are aware of, with your healthcare and anesthesia provider.
Q: Will an epidural have an effect on my baby?
A: Considerable research has shown that epidural anesthesia can be safe for both mother and baby. The baby is exposed to medications that are present in your blood stream and the amount of medication present is related to the dose. The spinal and epidural techniques use small doses; the local and IV techniques use larger amounts. The doses of medication used in labor epidurals typically will not cause an effect in you baby’s Apgar scores or behavior.
Q: Will the epidural slow down my labor?
A: There has been much debate and research on this topic. Generally, epidural anesthesia does not dramatically affect the progress of labor and delivery. Each patient is unique and will respond somewhat differently to the various epidural medications. Occasionally there will be a short period of decreased uterine contractions. Often times the epidural relaxes the patient and their labor may actually progress more quickly.
Q: What are the side effects and risks of an epidural/ spinal?
A: The most common side effects of epidurals/ spinals are: (a) A decrease in blood pressure due to relaxation of blood vessels and relief of pain. This is counteracted with increased IV fluids and/or medications to increase blood pressure. (b) Itching and/or nausea are possible side effects of the pain medications mixed in with the local anesthetic. (c) Shaking/ shivering are very common secondary to labor and/or the epidural medication’s effects. (d) Slight soreness, at the site of epidural insertion, may occur for several days.
When you drive a car, you know there is always a possibility of mechanical difficulties or an accident, but most of the time you reach your destination safely. The same is true with anesthesia for labor and delivery. Epidural/spinal risks do exist but are uncommon.
A: These techniques very often provide excellent labor and delivery pain relief and, if needed, surgical quality anesthesia for other procedures such as cesarean section or tubal ligation. It is possible, however, that they may not eliminate any or all of your pain. The catheter or needle must be placed in the proper position for the medication to work. Discomfort from labor and pregnancy and anatomic characteristics can make it difficult or impossible for you to get into an appropriate position for reliable needle and catheter insertion. Individuals vary in their response to the medications. Epidural catheters can be migrate or move out of position as you move. Variations in your anatomy, epidural space and back may not allow placement of the needle or catheter. It is possible, even with correct placement, to get pain relief in only some body areas and not in others (windows) or only on one side of your body (one sided block). Repositioning, redosing, or replacement of epidural catheters may be required. Your anesthetist will do everything possible to make you comfortable, but sometimes complete pain relief is not possible.
Q: How long does it take for the epidural to work?
A: Once the epidural catheter is placed, taped to your back securely, dressing applied, and tested for proper position, the starting, bolus dose is given. This dose usually takes 5-10 min. to begin working and 10-20 min. to get full effect. The first sensations you notice are often a feeling of warmth or tingling along with some numbness and heaviness in your legs. The goal is to block the sensation of contraction pain while leaving a feeling of pressure at the peak of contraction. You won’t be able to stand or get out of bed but there is usually adequate ability to turn and move your legs and good pushing ability at the time of delivery.
—Kip Bland CRNA, MSN, ARNP, Southwest Washington Medical Center, Family Birth Center, Department of Anesthesia
Q: I want to use organic and eco-friendly products for my new baby, but they can be so expensive. Where is it important that I buy all-natural products, and where can I skimp a bit?
A: As a baby planner when I provide advice to my clients I always recommend that they choose non-toxic, all-natural items for their baby that go into baby's mouth, touch baby's skin or may affect the air that their baby is breathing. Products such as certified organic crib bedding, baby clothing and non-toxic feeding gear are important areas to go "green" in. These types of green products not only keep baby safe from nasty chemicals but also help to preserve our earth.
Items such as teething toys and pacifiers should also be non-toxic and all-natural since baby will place these in her mouth quite often. Additionally, using low-VOC paint is also vital when painting baby's nursery so baby isn't breathing in toxic fumes.
Melissa Moog, Itsabelly Baby Concierge
Q: I gained a few extra pounds during my pregnancy. When can I come back to yoga after I deliver?
Dana Layon, E-RYT, Satsang Yoga, Vancouver, WA
Q: When will my baby have his first check-up?
— Carol Bunten, MD, The Vancouver Clinic
Q: How often should I bathe my baby?
A: Unlike older children and adults, babies don't require daily bathing. While it is important to thoroughly clean your baby after each diaper change, a bathing 2 to 3 times a week is plenty.
— Carol Bunten, MD, The Vancouver Clinic
Q: My baby has a crusty, scaly patch on his head. What is it?
A: This scaling, crusty, oily scalp is called cradle cap. It may appear on your baby's head during the first few months and is caused by oil glands that are working overtime. Although is doesn't look good, it doesn't itch, and it can be treated by washing the baby's head with a baby shampoo every few days. A baby brush and oil may help to loosen and remove cradle cap as well.
— Carol Bunten, MD, The Vancouver Clinic
Q: I just returned home from the hospital and I think I might have hemorrhoids. What should I do?
A: One of the most common after effects of pushing during labor is a hemorrhoid, or swollen blood vessels around the anus that may bleed and be painful. Depending on the severity of the swelling, you may want to soak your bottom in a few inches of warm water in the bath or wear a cotton pad soaked with cold witch hazel cream in the anal area. Eating foods high in fiber will help to alleviate constipation, which may exacerbate hemorrhoids. If the pain is unbearable, you may need prescription medicine.
— Carol Bunten, MD, The Vancouver Clinic
Q: Does the Apgar test determine the future health of my baby?
A: In general the Apgar score alone does not predict the future health of the baby. A low 5-minute Apgar score has been associated with a slight increased risk for cerebral palsy in full-term infants. However, 75% of children who develop this central nervous system disorder had normal Apgar scores. Read more about Apgar tests and scoring >
— Carol Bunten, MD, The Vancouver Clinic
Q: How will my older child do with a new baby?
A: Most kids do great when the new baby gets home, but there is often some transition. The older child is used to the routine that was present before the new arrival. The baby changes many things in their world and often the older sibling feels some displacement from mom. Many times parents tell me that their three year old wants to take the baby back to the hospital and get a baby that does not cry.
Expect some regression from the older child. They will want to be changed like the baby or misbehave. These actions are the older child trying to get attention that they perceive is being directed to the new arrival. If the child realizes that misbehaving does not get them attention, then the behaviors will stop. The other important tip is to focus on the older sibling when they do things that are positive. If the older child sees that being kind to the new baby and helping gets lots of praise, they will continue with those behaviors.
Make sure visitors who come to see you pay attention to the older child as well as the new baby. Special time and trips alone with the older sibling will show the child that being the big brother/sister is great because you get special privileges.
Q: My newborn has a scaly, itchy rash that I believe is eczema. How can I be sure it’s eczema, and if so, how can I treat it?
Q: Is there a relationship between vaccines and autism? I’ve heard so much about it lately, I don’t know what to believe!
A: I can understand how confusing and worrisome this is. Autism and related conditions such as Aspergers Syndrome may be increasing in frequency. Because of this, researchers have thoroughly sought to find a connection between specific vaccines (e.g. Measles) or preservatives such as Thimerosal. The information currently available overwhelmingly finds no link between vaccines and autism. Regardless of these negative findings, Thimerosal is no longer used in infant vaccines.
In a way vaccines are a victim of their own success, since most parents no longer recall seeing these vaccine preventable diseases. These germs are still out there, however, so we say: “Go the safe route and get the shots.”
Knowing where to get reliable, unbiased information is important. Here are some good resources I use and recommend.
The Children’s Hospital of Philadelphia is one of the nation’s top children’s hospitals. Their website provides a wealth of details regarding vaccine safety and the research and data to back up the information. Find out more from the Children's Hospital of Philadelphia >
What to Expect Guide to Immunizations. You can download this free booklet that answers parents’ many question about vaccines and vaccine safety in an easy to read format. Download the guide in English or Download the guide in Spanish